MEDICARE: ELITA WOLSK MA 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	1041C0700X	Clinical Social Worker		IL
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1114067865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELITA WOLSK MA LCSW

Provider Business Mailing Address
First Line	:	561 W DIVERSAY PARKWAY
Second Line	:	SUITE 216
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-528-0941
Fax Number	:	847-679-0780

Provider Business Practice Location Address
First Line	:	561 W DIVERSAY PARKWAY
Second Line	:	SUITE 216
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-528-0941
Fax Number	:	847-679-0780

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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