MEDICARE: MR. MICHAEL ROE LCSW, LCPC

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	149.016500	IL
2	101YP2500X	Professional Counselor	180.007091	IL

General Provider Information

NPI Number	:	1134475452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ROE LCSW, LCPC

Provider Business Mailing Address
First Line	:	1200 RING RD
Second Line	:	2454
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-7200
Country	:	US
Telephone Number	:	708-898-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 RING RD
Second Line	:	2454
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-7200
Country	:	US
Telephone Number	:	708-898-8745
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	04/30/2016

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