MEDICARE: TODD JUNKINS LCSW

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	150015340	IL
2	1041C0700X	Clinical Social Worker	149.019361	IL

General Provider Information

NPI Number	:	1043602097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD JUNKINS LCSW

Provider Business Mailing Address
First Line	:	53 W JACKSON BLVD STE 1632
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3606
Country	:	US
Telephone Number	:	847-563-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 1632
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3606
Country	:	US
Telephone Number	:	847-563-4010
Fax Number	:

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

Provider Enumeration Date	:	02/28/2015
Last Update Date	:	02/24/2020

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Directions to “ TODD JUNKINS LCSW” Practice Location

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