MEDICARE: PLATIQUEMOS THERAPY PLLC

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

General Provider Information

NPI Number	:	1336904663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATIQUEMOS THERAPY PLLC

Provider Business Mailing Address
First Line	:	4516 S SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 S SPRINGFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4042
Country	:	US
Telephone Number	:	847-502-1155
Fax Number	:

Authorized Official
Title or Position	:	OWNER & THERAPIST
Name	:	JENNIFER MOLLY MCCOOL
Credential	:	LCSW
Telephone Number	:	847-502-1155

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	06/17/2024

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