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NPI Code Detail

MEDICARE: MR. JACK PATRICK KANE JR. LCSW

MEDICARE: MR. JACK PATRICK KANE JR. LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149019919IL

General Provider Information

NPI Number : 1164184214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACK PATRICK KANE JR. LCSW
Provider Business Mailing Address
First Line : 9697 191ST ST STE 200
Second Line :
City : MOKENA
State : IL
Zip : 60448-8617
Country : US
Telephone Number : 630-646-6540
Fax Number : 630-646-6542
Provider Business Practice Location Address
First Line : 9697 191ST ST
Second Line :
City : MOKENA
State : IL
Zip : 60448-8609
Country : US
Telephone Number : 630-646-6559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2021
Last Update Date : 05/06/2024

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Directions to “ MR. JACK PATRICK KANE JR. LCSW” Practice Location

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