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NPI Code Detail

MEDICARE: TIFFANY MICEK LCSW

MEDICARE: TIFFANY MICEK 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
1104100000XSocial Worker150106104IL

General Provider Information

NPI Number : 1295431484
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY MICEK LCSW
Provider Business Mailing Address
First Line : 1425 MELROSE AVE
Second Line :
City : ROUND LAKE BEACH
State : IL
Zip : 60073-2059
Country : US
Telephone Number : 847-773-7474
Fax Number :
Provider Business Practice Location Address
First Line : 1860 W WINCHESTER RD STE 205
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5317
Country : US
Telephone Number : 224-424-4102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2023
Last Update Date : 03/13/2024

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Directions to “ TIFFANY MICEK LCSW” Practice Location

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