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General NPI Number Information
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NPI Number | 1548421126
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Entity Type | Individual
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Provider Name | JENNIFER MEADE MAGRUDER LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2515 N CLARK ST 8TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60614-2730
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Country | US
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Telephone | 773-880-4882
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Fax | 773-880-8314
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Provider Business Mailing Address
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Address Line | 2202 W 107TH PL
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City | CHICAGO
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State | IL
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Zip | 60643-3120
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Country | US
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Telephone | 773-880-4882
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Fax | 773-880-8314
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011447
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License Number State | IL
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