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NPI Code Detail

MEDICARE: MS. ANNA B. FALLON MSW, LCSW

MEDICARE: MS. ANNA B. FALLON MSW, 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
1104100000XSocial Worker12430223IL

General Provider Information

NPI Number : 1447282884
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNA B. FALLON MSW, LCSW
Provider Business Mailing Address
First Line : 4660 N LECLAIRE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3817
Country : US
Telephone Number : 773-283-3494
Fax Number :
Provider Business Practice Location Address
First Line : 3003 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-2833
Country : US
Telephone Number : 773-508-1137
Fax Number : 773-262-7084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/09/2007

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