MEDICARE: CARLLIE MEEKS

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	150107663	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150107663	OTHER	IL	LSW LICENCE NUMBER

General Provider Information

NPI Number	:	1992427728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLLIE MEEKS

Provider Business Mailing Address
First Line	:	3139 N LINCOLN AVE STE 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3173
Country	:	US
Telephone Number	:	402-598-5307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE STE 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3173
Country	:	US
Telephone Number	:	402-598-5307
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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Directions to “ CARLLIE MEEKS ” Practice Location

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