MEDICARE: GARNADETTE STUCKEY

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	149017035	IL

General Provider Information

NPI Number	:	1073199170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARNADETTE STUCKEY

Provider Business Mailing Address
First Line	:	1384 FOREST AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6046
Country	:	US
Telephone Number	:	708-541-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1384 FOREST AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6046
Country	:	US
Telephone Number	:	708-541-5596
Fax Number	:

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

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	03/20/2021

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Directions to “ GARNADETTE STUCKEY ” Practice Location

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