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General NPI Number Information
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NPI Number | 1790295871
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Entity Type | Individual
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Provider Name | TATUM MEGUMI STEWART MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 05/10/2019
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Provider Practice Location Address
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Address Line | 2418 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2940
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Country | US
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Telephone | 312-432-4573
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N FAIRFIELD AVE FL 1
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City | CHICAGO
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State | IL
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Zip | 60622-4454
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Country | US
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Telephone | 217-722-9317
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.102618
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-020132
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License Number State | IL
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