MEDICARE: JULIE ANDERSON L.C.S.W.

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	149.013237	IL

General Provider Information

NPI Number	:	1275830697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANDERSON L.C.S.W.

Provider Business Mailing Address
First Line	:	3963 W BELMONT AVE
Second Line	:	UNIT 220
City	:	CHICAGO
State	:	IL
Zip	:	60618-5149
Country	:	US
Telephone Number	:	773-368-2739
Fax Number	:

Provider Business Practice Location Address
First Line	:	3963 W BELMONT AVE
Second Line	:	UNIT 220
City	:	CHICAGO
State	:	IL
Zip	:	60618-5149
Country	:	US
Telephone Number	:	773-368-2739
Fax Number	:

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	02/21/2011

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