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NPI Code Detail

MEDICARE: CONNIE RAYYAN

MEDICARE: CONNIE RAYYAN
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 Worker149.016486IL

General Provider Information

NPI Number : 1871903443
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE RAYYAN
Provider Business Mailing Address
First Line : 5730 WEST ROOSEVELT ROAD
Second Line :
City : CHICAGO
State : IL
Zip : 60644
Country : US
Telephone Number : 773-413-1700
Fax Number : 773-413-1795
Provider Business Practice Location Address
First Line : 5730 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-1580
Country : US
Telephone Number : 773-413-1700
Fax Number : 773-413-1795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2014
Last Update Date : 05/05/2014

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