MEDICARE: TERESA BERNADETTE LINDAHL LSW

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	150.109960	IL
2	104100000X	Social Worker	150109960	IL

General Provider Information

NPI Number	:	1245945286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA BERNADETTE LINDAHL LSW

Provider Business Mailing Address
First Line	:	224 W JUDD ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3199
Country	:	US
Telephone Number	:	815-345-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 W JUDD ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3199
Country	:	US
Telephone Number	:	815-345-3400
Fax Number	:	844-734-1259

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

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	01/13/2023

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