MEDICARE: MS. MADELEINE ROONEY MSW

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		IL

General Provider Information

NPI Number	:	1083835656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADELEINE ROONEY MSW

Provider Business Mailing Address
First Line	:	734 W. WILLOW ST.
Second Line	:	UNIT 3
City	:	CHICAGO
State	:	IL
Zip	:	60614-5151
Country	:	US
Telephone Number	:	312-664-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 S. PAULINA ST.
Second Line	:	SUITE 432
City	:	CHICAGO
State	:	IL
Zip	:	60612-3814
Country	:	US
Telephone Number	:	312-942-6995
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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