MEDICARE: JULIE TROOB LCSW, ACHT

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	149.013605	IL

General Provider Information

NPI Number	:	1225351166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE TROOB LCSW, ACHT

Provider Business Mailing Address
First Line	:	530 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1669
Country	:	US
Telephone Number	:	773-540-8306
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 W DIVERSEY PKWY
Second Line	:	SUITE 216
City	:	CHICAGO
State	:	IL
Zip	:	60614-6068
Country	:	US
Telephone Number	:	773-540-8306
Fax Number	:

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

Provider Enumeration Date	:	03/06/2010
Last Update Date	:	05/21/2011

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