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NPI Code Detail

MEDICARE: MICKIA DAVIS

MEDICARE: MICKIA DAVIS
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
11041S0200XSchool Social WorkerIL

General Provider Information

NPI Number : 1437363934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICKIA DAVIS
Provider Business Mailing Address
First Line : 1850 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1850 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1228
Country : US
Telephone Number : 312-666-1331
Fax Number : 312-506-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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Directions to “ MICKIA DAVIS ” Practice Location

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