MEDICARE: ERIN DANIELLE OBRADOVICH L.C.S.W

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	104100000X	Social Worker	150.014702	IL
2	1041C0700X	Clinical Social Worker	149.017993	IL

General Provider Information

NPI Number	:	1851712392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN DANIELLE OBRADOVICH L.C.S.W

Provider Business Mailing Address
First Line	:	5100 N. RAVENSWOOD AVE.
Second Line	:	SUITE 231
City	:	CHICAGO
State	:	IL
Zip	:	60657-1710
Country	:	US
Telephone Number	:	630-935-8107
Fax Number	:	773-661-4762

Provider Business Practice Location Address
First Line	:	5100 N. RAVENSWOOD AVE.
Second Line	:	SUITE 231
City	:	CHICAGO
State	:	IL
Zip	:	60657-1710
Country	:	US
Telephone Number	:	630-935-8107
Fax Number	:	773-661-4762

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

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	12/05/2015

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