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NPI Code Detail

MEDICARE: JULIE A SUPPLE LCSW

MEDICARE: JULIE A SUPPLE 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
1104100000XSocial Worker34003062AIN
21041C0700XClinical Social Worker34003062AIN

General Provider Information

NPI Number : 1831464510
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A SUPPLE LCSW
Provider Business Mailing Address
First Line : 5537 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1405
Country : US
Telephone Number : 773-989-9400
Fax Number : 773-989-9494
Provider Business Practice Location Address
First Line : 5537 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1405
Country : US
Telephone Number : 773-989-9400
Fax Number : 773-989-9494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2012
Last Update Date : 03/14/2012

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Directions to “ JULIE A SUPPLE LCSW” Practice Location

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