MEDICARE: JENNIFER GARFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149.00845	OTHER	IL	BLUE SHIELD

General Provider Information

NPI Number	:	1023124690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GARFIELD

Provider Business Mailing Address
First Line	:	1580 SHERMAN AVE
Second Line	:	UNIT 705
City	:	EVANSTON
State	:	IL
Zip	:	60201-4465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2134
Country	:	US
Telephone Number	:	312-226-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/04/2007

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