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NPI Code Detail

MEDICARE: AMY TANNER LCSW

MEDICARE: AMY TANNER 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 Worker149.011144IL

General Provider Information

NPI Number : 1134265077
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY TANNER LCSW
Provider Business Mailing Address
First Line : 5805 W EDDY ST
Second Line : UNIT 1D
City : CHICAGO
State : IL
Zip : 60634-4390
Country : US
Telephone Number : 773-430-1075
Fax Number :
Provider Business Practice Location Address
First Line : 61 S OLD RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-3127
Country : US
Telephone Number : 847-438-4222
Fax Number : 847-438-0844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 02/13/2009

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