MEDICARE: ISABELLA R THOMPSON LSW

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	104100000X	Social Worker	150.109934	IL

General Provider Information

NPI Number	:	1205549847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA R THOMPSON LSW

Provider Business Mailing Address
First Line	:	4321 N TRIPP AVE APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2028
Country	:	US
Telephone Number	:	616-648-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 N RAVENSWOOD AVENUE
Second Line	:	FLOOR 3 #326
City	:	CHICAGO
State	:	IL
Zip	:	60613-1192
Country	:	US
Telephone Number	:	847-865-8440
Fax Number	:

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

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	12/28/2022

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