MEDICARE: JONATHAN MATTHEW LSW

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	150.11384	IL

General Provider Information

NPI Number	:	1477383925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MATTHEW LSW

Provider Business Mailing Address
First Line	:	901 W ASPEN CT
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-0712
Country	:	US
Telephone Number	:	847-830-1773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3166 N LINCOLN AVE STE 400B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3174
Country	:	US
Telephone Number	:	312-529-8415
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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