MEDICARE: EMMA ANN PALMER 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	150.104054	IL
2	1041C0700X	Clinical Social Worker	149.025252	IL

General Provider Information

NPI Number	:	1588297485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA ANN PALMER LCSW

Provider Business Mailing Address
First Line	:	2000 N RACINE AVE STE 2190
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7007
Country	:	US
Telephone Number	:	773-220-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N RACINE AVE STE 2190
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7007
Country	:	US
Telephone Number	:	612-655-5841
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	03/07/2023

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