MEDICARE: MS. KRISTIN KATHLEEN REITZ 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	149.015132	IL

General Provider Information

NPI Number	:	1750635793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN KATHLEEN REITZ LCSW

Provider Business Mailing Address
First Line	:	3516 N OAKLEY AVE
Second Line	:	APT. 2
City	:	CHICAGO
State	:	IL
Zip	:	60618-6024
Country	:	US
Telephone Number	:	440-479-0614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 N OAKLEY AVE
Second Line	:	APT. 2
City	:	CHICAGO
State	:	IL
Zip	:	60618-6024
Country	:	US
Telephone Number	:	440-479-0614
Fax Number	:

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

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	10/29/2012

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