MEDICARE: MRS. ANNA GRANNEMAN 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	149.016184	IL

General Provider Information

NPI Number	:	1265852891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA GRANNEMAN LCSW

Provider Business Mailing Address
First Line	:	1921 W BELLE PLAINE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1828
Country	:	US
Telephone Number	:	773-459-7410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 W BELLE PLAINE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1828
Country	:	US
Telephone Number	:	773-459-7410
Fax Number	:

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

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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