MEDICARE: DANIEL WILLIAM ROSS 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	C-10005	NM
2	1041C0700X	Clinical Social Worker	149.023744	IL

General Provider Information

NPI Number	:	1538550819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WILLIAM ROSS LCSW

Provider Business Mailing Address
First Line	:	469 ENFIELD LN
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-4424
Country	:	US
Telephone Number	:	224-501-0479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1790 NATIONS DR STE 214
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-9176
Country	:	US
Telephone Number	:	224-501-0479
Fax Number	:

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

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	11/15/2023

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