MEDICARE: MICHELLE MARTHA BAUTISTA 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	149.011952	IL

General Provider Information

NPI Number	:	1346441250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARTHA BAUTISTA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 12454
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-0454
Country	:	US
Telephone Number	:	773-480-3412
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 W 18TH ST STE 219
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2400
Country	:	US
Telephone Number	:	773-480-3412
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	09/28/2021

Similar Medicare Providers

1811783079 — THE PHOENIX CLINIC NFP
Practice Location Address:

917 W 18TH ST STE 325
CHICAGO, IL
60608-2400

Practice Phone: 773-431-7397
Practice Fax:

1447112297 — SUKOON BEHAVIORAL PLLC
Practice Location Address:

917 W 18TH ST STE 316
CHICAGO, IL
60608-2400

Practice Phone: 618-713-5547
Practice Fax:

1346696952 — SORAB BEDI
Practice Location Address:

2400 W BROSS AVE
CHICAGO, IL
60608-5168

Practice Phone: 708-205-8288
Practice Fax:

1114430857 — SUSIE LIANA MOYA
Practice Location Address:

917 W 18TH ST STE 216
CHICAGO, IL
60608-2400

Practice Phone: 708-581-8018
Practice Fax:

1184289118 — EMBRACE CORAZON COUNSELING PC
Practice Location Address:

917 W 18TH ST STE 216
CHICAGO, IL
60608-2400

Practice Phone: 708-581-8018
Practice Fax:

1568081172 — DR. SAMANTHA C COLLAZO PSY.D.
Practice Location Address:

917 W 18TH ST STE 203
CHICAGO, IL
60608-2400

Practice Phone: 312-620-5241
Practice Fax:

Directions to “ MICHELLE MARTHA BAUTISTA LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.