MEDICARE: MS. ANDREA ELIZABETH FREERKSEN

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

General Provider Information

NPI Number	:	1043595218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA ELIZABETH FREERKSEN

Provider Business Mailing Address
First Line	:	3445 S RHODES AVE
Second Line	:	APT 204
City	:	CHICAGO
State	:	IL
Zip	:	60616-4252
Country	:	US
Telephone Number	:	773-542-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 53RD ST
Second Line	:	STE 503
City	:	CHICAGO
State	:	IL
Zip	:	60615-4530
Country	:	US
Telephone Number	:	773-542-3493
Fax Number	:

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	03/13/2018

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