MEDICARE: MRS. JACQUELINE R PANGILINAN 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	149010343	IL

General Provider Information

NPI Number	:	1710293055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE R PANGILINAN LCSW

Provider Business Mailing Address
First Line	:	1215 ORLEANS DR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4858
Country	:	US
Telephone Number	:	847-362-5483
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 ORLEANS DR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4858
Country	:	US
Telephone Number	:	847-362-5483
Fax Number	:

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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