MEDICARE: RYAN WESNESKI 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
1	1041C0700X	Clinical Social Worker	149.017266	IL

General Provider Information

NPI Number	:	1306298864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN WESNESKI LCSW

Provider Business Mailing Address
First Line	:	7559 N ROGERS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1709
Country	:	US
Telephone Number	:	918-914-3875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-0195
Country	:	US
Telephone Number	:	918-914-3875
Fax Number	:

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	04/24/2017

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