MEDICARE: RACHEL SONTAG

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	104100000X	Social Worker	150.014817	IL

General Provider Information

NPI Number	:	1023428950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL SONTAG

Provider Business Mailing Address
First Line	:	2515 W WINNEMAC
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5547 N RAVENSWOOD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60691
Country	:	US
Telephone Number	:	773-506-3056
Fax Number	:

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

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	04/30/2014

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Directions to “ RACHEL SONTAG ” Practice Location

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