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NPI Code Detail

MEDICARE: EVELYN JOY COKER LCSW

MEDICARE:   EVELYN JOY COKER  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
11041C0700XClinical Social Worker149.014732IL

General Provider Information

NPI Number : 1295087997
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN JOY COKER LCSW
Provider Business Mailing Address
First Line : 6342 S KENWOOD AVE
Second Line : APT 1
City : CHICAGO
State : IL
Zip : 60637-3767
Country : US
Telephone Number : 773-803-9587
Fax Number :
Provider Business Practice Location Address
First Line : 6342 S. KENWOOD AVE
Second Line : APT 1
City : CHICAGO
State : IL
Zip : 60637-3767
Country : US
Telephone Number : 773-803-9587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2012
Last Update Date : 10/05/2012

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Directions to “ EVELYN JOY COKER LCSW” Practice Location

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