MEDICARE: KIERRA PAULY LMSW, 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	149030334	IL
2	104100000X	Social Worker	113046	IA

General Provider Information

NPI Number	:	1275253783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERRA PAULY LMSW, LSW

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N MILL ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-6301
Country	:	US
Telephone Number	:	630-206-4060
Fax Number	:	855-871-8351

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	12/12/2025

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