MEDICARE: MS. JUANITA GUILLERMO LCSW, ACSW

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		IL

General Provider Information

NPI Number	:	1508995812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUANITA GUILLERMO LCSW, ACSW

Provider Business Mailing Address
First Line	:	4223 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2515
Country	:	US
Telephone Number	:	773-267-7819
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 N WHIPPLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2515
Country	:	US
Telephone Number	:	773-267-7819
Fax Number	:

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	07/08/2007

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