MEDICARE: WILLIAM B. SWIERINGA 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	149.010142	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06575749	OTHER	IL	SECRETARY OF STATE FILE NUMBER

General Provider Information

NPI Number	:	1427693951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM B. SWIERINGA LCSW

Provider Business Mailing Address
First Line	:	4940 S EAST END AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-6022
Country	:	US
Telephone Number	:	312-288-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 S EAST END AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-6022
Country	:	US
Telephone Number	:	312-288-5059
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	06/09/2020

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