MEDICARE: QUENTON CARDELL ANDERSON

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	104100000X	Social Worker	150.108327	IL

General Provider Information

NPI Number	:	1376250506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENTON CARDELL ANDERSON

Provider Business Mailing Address
First Line	:	9730 S WESTERN AVE STE 203
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2854
Country	:	US
Telephone Number	:	708-572-3683
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 WEST 95TH STREET
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-6045
Country	:	US
Telephone Number	:	708-529-0278
Fax Number	:

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	06/03/2026

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Directions to “ QUENTON CARDELL ANDERSON ” Practice Location

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