=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992718001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA FREEDMAN M.S.W., PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7141 N KEDZIE AVE APT 511
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60645-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-274-1252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7141 N KEDZIE AVE APT 511
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60645-2823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-274-1252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149003103
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------