MEDICARE: KAREN KALLIEL 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
1	1041C0700X	Clinical Social Worker	149-011096	IL

General Provider Information

NPI Number	:	1346488632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KALLIEL LCSW

Provider Business Mailing Address
First Line	:	4970 N MARINE DR APT 326
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3925
Country	:	US
Telephone Number	:	773-837-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4537 N ARTESIAN AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3003
Country	:	US
Telephone Number	:	773-837-8207
Fax Number	:

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

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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