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NPI Code Detail

MEDICARE: JINXIAO TAN LCSW

MEDICARE: JINXIAO TAN 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
11041C0700XClinical Social Worker149.028079IL

General Provider Information

NPI Number : 1417770132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JINXIAO TAN LCSW
Provider Business Mailing Address
First Line : 2141 S TAN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1998
Country : US
Telephone Number : 312-791-0418
Fax Number : 312-815-7302
Provider Business Practice Location Address
First Line : 2141 S TAN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1998
Country : US
Telephone Number : 312-791-0418
Fax Number : 312-815-7302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2024
Last Update Date : 11/01/2024

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Directions to “ JINXIAO TAN LCSW” Practice Location

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