MEDICARE: MS. KORI C. MILL MA, 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001634097	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1447464599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KORI C. MILL MA, LCSW

Provider Business Mailing Address
First Line	:	1140 W PRATT BLVD
Second Line	:	#2E
City	:	CHICAGO
State	:	IL
Zip	:	60626-4413
Country	:	US
Telephone Number	:	773-338-7164
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 N LINCOLN AVE
Second Line	:	#218
City	:	CHICAGO
State	:	IL
Zip	:	60614-2353
Country	:	US
Telephone Number	:	773-869-6092
Fax Number	:	773-869-2371

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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