MEDICARE: MS. ALICIA T MEADE M.A

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
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1164646980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA T MEADE M.A

Provider Business Mailing Address
First Line	:	3314 WESLEY AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3414
Country	:	US
Telephone Number	:	708-305-3305
Fax Number	:	708-660-0174

Provider Business Practice Location Address
First Line	:	1142 CHICAGO AVE
Second Line	:	W2
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:	708-305-3305
Fax Number	:	708-660-0174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/09/2007

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