MEDICARE: WENDI LEV LCSW, ACSW, CADC

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	149008169	IL

General Provider Information

NPI Number	:	1134389901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDI LEV LCSW, ACSW, CADC

Provider Business Mailing Address
First Line	:	165 N CANAL ST
Second Line	:	905
City	:	CHICAGO
State	:	IL
Zip	:	60606-1549
Country	:	US
Telephone Number	:	312-203-2979
Fax Number	:	847-432-1016

Provider Business Practice Location Address
First Line	:	165 N CANAL ST
Second Line	:	905
City	:	CHICAGO
State	:	IL
Zip	:	60606-1549
Country	:	US
Telephone Number	:	312-203-2979
Fax Number	:	847-432-1016

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

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	06/14/2008

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