MEDICARE: MS. ALEJANDRA GUTIERREZ LCSW

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	149.018643	IL
2	1041C0700X	Clinical Social Worker	83255	CA

General Provider Information

NPI Number	:	1194473876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEJANDRA GUTIERREZ LCSW

Provider Business Mailing Address
First Line	:	5747 S MASSASOIT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3740
Country	:	US
Telephone Number	:	773-808-8763
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 S MASSASOIT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3740
Country	:	US
Telephone Number	:	773-808-8763
Fax Number	:

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

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/12/2022

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