MEDICARE: MRS. JEAN HAUSMANN 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	ISW02189	RI
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1124379003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN HAUSMANN LCSW

Provider Business Mailing Address
First Line	:	433 W BRIAR PL
Second Line	:	APT 5C
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	401-871-6996
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 W BRIAR PL APT 5C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4762
Country	:	US
Telephone Number	:	401-871-6996
Fax Number	:

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	09/26/2023

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