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NPI Code Detail

MEDICARE: MS. MARALINE PATRICIA MATTKE M.S.W., L.C.S.W.

MEDICARE: MS. MARALINE PATRICIA MATTKE M.S.W., L.C.S.W.
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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1285707877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARALINE PATRICIA MATTKE M.S.W., L.C.S.W.
Provider Business Mailing Address
First Line : 250 WATER STONE CIR
Second Line :
City : JOLIET
State : IL
Zip : 60431-8313
Country : US
Telephone Number : 815-740-4104
Fax Number : 815-740-4107
Provider Business Practice Location Address
First Line : 250 WATER STONE CIR
Second Line :
City : JOLIET
State : IL
Zip : 60431-8313
Country : US
Telephone Number : 815-740-4104
Fax Number : 815-740-4107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/08/2007

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Practice Location Address:
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1891992681 — MISS VEVECA A TIKASINGH L.C.S.W
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1760689145 — RUBY DIANNE RICHARDSON LCSW
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Directions to “ MS. MARALINE PATRICIA MATTKE M.S.W., L.C.S.W.” Practice Location

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