MEDICARE: HANNAH CARLSON LCSW PLLC

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

General Provider Information

NPI Number	:	1295383651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNAH CARLSON LCSW PLLC

Provider Business Mailing Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	312-425-4372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	312-425-4372
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	HANNAH CARLSON
Credential	:	LCSW
Telephone Number	:	312-425-4372

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	06/25/2022

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