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NPI Code Detail

MEDICARE: RICHARD JAJKO LSW

MEDICARE: RICHARD JAJKO LSW
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
11041C0700XClinical Social Worker150005921IL

General Provider Information

NPI Number : 1043732696
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD JAJKO LSW
Provider Business Mailing Address
First Line : 3249 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-4360
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3249 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-4360
Country : US
Telephone Number : 773-371-3710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2017
Last Update Date : 07/14/2017

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