MEDICARE: KISKA TITHINUNN PIPER

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	104100000X	Social Worker	150109605	IL

General Provider Information

NPI Number	:	1285481465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISKA TITHINUNN PIPER

Provider Business Mailing Address
First Line	:	2954 W IRVING PARK RD APT 3F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3508
Country	:	US
Telephone Number	:	310-733-6626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 N LARRABEE ST APT 6303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4423
Country	:	US
Telephone Number	:	310-733-6626
Fax Number	:

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

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	01/14/2025

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