MEDICARE: MS. KATHERINE ANN KRAJCI MA

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	149012208	IL

General Provider Information

NPI Number	:	1134290083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE ANN KRAJCI MA

Provider Business Mailing Address
First Line	:	3740 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4527
Country	:	US
Telephone Number	:	773-844-1278
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 S PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3808
Country	:	US
Telephone Number	:	312-563-2703
Fax Number	:	312-942-6116

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/06/2010

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