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NPI Code Detail

MEDICARE: MALLORY SIEGEL-ELLIOTT LMSW

MEDICARE: MALLORY SIEGEL-ELLIOTT LMSW
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 Worker150.112434IL

General Provider Information

NPI Number : 1134990161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY SIEGEL-ELLIOTT LMSW
Provider Business Mailing Address
First Line : 8765 W HIGGINS RD STE 450
Second Line :
City : CHICAGO
State : IL
Zip : 60631-4172
Country : US
Telephone Number : 773-693-0300
Fax Number :
Provider Business Practice Location Address
First Line : 3753 S COTTAGE GROVE AVE STE 2
Second Line :
City : CHICAGO
State : IL
Zip : 60653-1662
Country : US
Telephone Number : 773-693-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2024
Last Update Date : 01/09/2024

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Directions to “ MALLORY SIEGEL-ELLIOTT LMSW” Practice Location

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