=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750371183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK JOSEPH AHERN JD LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2210 DEAN ST STE O1
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175-1066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-587-6910
-----------------------------------------------------
Fax | 630-587-4928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2210 DEAN ST STE O1
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175-1066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-587-6910
-----------------------------------------------------
Fax | 630-587-4928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 49006411
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------