MEDICARE: JOANNA VANLEAR 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	149.017652	IL

General Provider Information

NPI Number	:	1316311889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA VANLEAR LCSW

Provider Business Mailing Address
First Line	:	111 WOODLAND CIR
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-3321
Country	:	US
Telephone Number	:	630-688-7885
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S LINCOLNWAY
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1663
Country	:	US
Telephone Number	:	630-801-1669
Fax Number	:

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

Provider Enumeration Date	:	11/21/2015
Last Update Date	:	11/21/2015

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