MEDICARE: LISA MIREILLE HARTLIEB

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		IL

General Provider Information

NPI Number	:	1437005154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MIREILLE HARTLIEB

Provider Business Mailing Address
First Line	:	659 ORCHARD ST
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-1237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 JUNCTION DRIVE WESST
Second Line	:	SUITE 3
City	:	GLEN CARBON
State	:	IL
Zip	:	62034
Country	:	US
Telephone Number	:	618-710-4123
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ LISA MIREILLE HARTLIEB ” Practice Location

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