MEDICARE: JFSW, INC.

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	101YP2500X	Professional Counselor	180-003418	IL
2	106H00000X	Marriage & Family Therapist	166-000517	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633354	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508931478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JFSW, INC.

Provider Business Mailing Address
First Line	:	3648 GUNDERSON AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3878
Country	:	US
Telephone Number	:	708-788-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	7627 LAKE ST STE 213
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1878
Country	:	US
Telephone Number	:	708-488-8000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. RICHELLE MARIE WILLIAMS
Credential	:	LCPC, LMFT, CADC
Telephone Number	:	708-488-8000

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	01/28/2009

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Directions to “JFSW, INC. ” Practice Location

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