MEDICARE: MS. JOAN A HALLAM 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	149.004989	IL

General Provider Information

NPI Number	:	1194872473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN A HALLAM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1488
Second Line	:	2960 CHARTRES STREET
City	:	LA SALLE
State	:	IL
Zip	:	61301-3488
Country	:	US
Telephone Number	:	815-224-1610
Fax Number	:	815-223-1634

Provider Business Practice Location Address
First Line	:	17 NORTH POINT PLAZA
Second Line	:
City	:	STREATOR
State	:	IL
Zip	:	61364-1159
Country	:	US
Telephone Number	:	815-673-3388
Fax Number	:	815-673-1437

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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