MEDICARE: HILARY E KOHS LCSW, ACSW

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	149011760	IL

General Provider Information

NPI Number	:	1235386509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILARY E KOHS LCSW, ACSW

Provider Business Mailing Address
First Line	:	2095 E TRACY ST
Second Line	:
City	:	DIAMOND
State	:	IL
Zip	:	60416-9409
Country	:	US
Telephone Number	:	815-823-6972
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 E TRACY ST
Second Line	:
City	:	DIAMOND
State	:	IL
Zip	:	60416-9409
Country	:	US
Telephone Number	:	815-823-6972
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	02/02/2020

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