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NPI Code Detail

MEDICARE: YUKAKO ISHIGURO SORTINO LCSW

MEDICARE: YUKAKO ISHIGURO SORTINO 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 Worker149026091IL

General Provider Information

NPI Number : 1649047036
Entity Type Code : Individual
Provider Name (Legal Business Name) : YUKAKO ISHIGURO SORTINO LCSW
Provider Business Mailing Address
First Line : 5311 S HARPER AVE APT 3
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4686
Country : US
Telephone Number : 630-386-5317
Fax Number :
Provider Business Practice Location Address
First Line : 4009 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2110
Country : US
Telephone Number : 773-275-2586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2023
Last Update Date : 09/27/2024

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