MEDICARE: MEREDITH MCQUISTON 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	149020054	IL

General Provider Information

NPI Number	:	1891180436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MCQUISTON LCSW

Provider Business Mailing Address
First Line	:	650 N DEARBORN ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5358
Country	:	US
Telephone Number	:	312-970-1087
Fax Number	:	312-291-9723

Provider Business Practice Location Address
First Line	:	650 N DEARBORN ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5358
Country	:	US
Telephone Number	:	312-970-1087
Fax Number	:	312-291-9723

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	01/24/2020

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