MEDICARE: LANI GRANUM M.A., L.C.S.W.

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	149000357	IA

General Provider Information

NPI Number	:	1336362003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANI GRANUM M.A., L.C.S.W.

Provider Business Mailing Address
First Line	:	5433 S EAST VIEW PARK
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5915
Country	:	US
Telephone Number	:	773-752-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 E WACKER DR
Second Line	:	#4307
City	:	CHICAGO
State	:	IL
Zip	:	60601-5104
Country	:	US
Telephone Number	:	312-946-8413
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	11/10/2009

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