Healthcare Provider Details

I. General information

NPI: 1396831434
Provider Name (Legal Business Name): JUDY RANNIGER-MEZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W GREENLEAF AVE
CHICAGO IL
60626-2805
US

IV. Provider business mailing address

1400 W GREENLEAF AVE
CHICAGO IL
60626-2805
US

V. Phone/Fax

Practice location:
  • Phone: 773-508-6100
  • Fax: 773-262-2841
Mailing address:
  • Phone: 773-508-6100
  • Fax: 773-262-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: