MEDICARE: JOSHUA ANNEX

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	149.017410	IL

General Provider Information

NPI Number	:	1336526995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ANNEX

Provider Business Mailing Address
First Line	:	1057 CARLYLE TER
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4033
Country	:	US
Telephone Number	:	917-520-1614
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 N BROADWAY ST STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6076
Country	:	US
Telephone Number	:	773-558-7029
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	12/19/2025

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Directions to “ JOSHUA ANNEX ” Practice Location

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