MEDICARE: SHIPRA PANICKER 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	1041C0700X	Clinical Social Worker	149.020909	IL

General Provider Information

NPI Number	:	1508741653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIPRA PANICKER LCSW

Provider Business Mailing Address
First Line	:	1043 N WINCHESTER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 N WINCHESTER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7236
Country	:	US
Telephone Number	:	918-760-2435
Fax Number	:

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

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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Directions to “ SHIPRA PANICKER LCSW” Practice Location

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