MEDICARE: JON D HSIEH 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	149-010274	IL

General Provider Information

NPI Number	:	1124029988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON D HSIEH LCSW

Provider Business Mailing Address
First Line	:	1120 E MAIN ST
Second Line	:	STE. 201
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2287
Country	:	US
Telephone Number	:	630-377-6613
Fax Number	:	630-377-6225

Provider Business Practice Location Address
First Line	:	207 E CHURCH ST
Second Line	:	SUITE A
City	:	SANDWICH
State	:	IL
Zip	:	60548-9803
Country	:	US
Telephone Number	:	815-786-8606
Fax Number	:	815-786-1541

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/13/2017

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Directions to “ JON D HSIEH LCSW” Practice Location

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