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NPI Code Detail

MEDICARE: MOLLY OLDER LCSW

MEDICARE: MOLLY OLDER 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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1114137163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY OLDER LCSW
Provider Business Mailing Address
First Line : 943 N WOLCOTT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4941
Country : US
Telephone Number : 773-394-9638
Fax Number :
Provider Business Practice Location Address
First Line : 1969 W OGDEN AVE
Second Line : ROOM 1698
City : CHICAGO
State : IL
Zip : 60612-3765
Country : US
Telephone Number : 312-864-2404
Fax Number : 312-864-9238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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Directions to “ MOLLY OLDER LCSW” Practice Location

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