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NPI Code Detail

MEDICARE: JILL ANN BAJOREK LCSW

MEDICARE:   JILL ANN BAJOREK  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 Worker149.015646IL

General Provider Information

NPI Number : 1174862619
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL ANN BAJOREK LCSW
Provider Business Mailing Address
First Line : 620 W ADDISON ST
Second Line : 206
City : CHICAGO
State : IL
Zip : 60613-4402
Country : US
Telephone Number : 708-927-8881
Fax Number : 708-763-1044
Provider Business Practice Location Address
First Line : 3656 N HALSTED ST
Second Line : STE A
City : CHICAGO
State : IL
Zip : 60613-5974
Country : US
Telephone Number : 773-472-6643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2013
Last Update Date : 02/04/2013

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Directions to “ JILL ANN BAJOREK LCSW” Practice Location

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