MEDICARE: MR. RONALD SKOLBA LCSW, 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	149-005770	IL

General Provider Information

NPI Number	:	1144400326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD SKOLBA LCSW, CADC

Provider Business Mailing Address
First Line	:	5410 JOHNSON AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1949
Country	:	US
Telephone Number	:	708-209-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 EAST AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2639
Country	:	US
Telephone Number	:	708-749-7105
Fax Number	:

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	04/04/2016

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