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NPI Code Detail

MEDICARE: MARIBEL RUIZ EGGLESTON LCSW

MEDICARE: MARIBEL RUIZ EGGLESTON 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
11041C0700XClinical Social Worker149014474IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11616824OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1477840528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIBEL RUIZ EGGLESTON LCSW
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE STE 1217
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3732
Country : US
Telephone Number : 815-252-6602
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 1217
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3732
Country : US
Telephone Number : 815-252-6602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2011
Last Update Date : 07/21/2015

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