MEDICARE: MS. MARY JOANNE MILLER 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	104100000X	Social Worker		IL

General Provider Information

NPI Number	:	1447225321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JOANNE MILLER LCSW

Provider Business Mailing Address
First Line	:	6115 N MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3914
Country	:	US
Telephone Number	:	773-792-8586
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N NORTHWEST HWY
Second Line	:	145
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3263
Country	:	US
Telephone Number	:	847-685-9900
Fax Number	:	847-685-6390

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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