MEDICARE: MS. JULIE MCLEAN 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		IL

General Provider Information

NPI Number	:	1518079599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE MCLEAN LCSW

Provider Business Mailing Address
First Line	:	1212 TENNYSON LN
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-0330
Country	:	US
Telephone Number	:	630-305-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 E 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-2302
Country	:	US
Telephone Number	:	773-487-0515
Fax Number	:	773-487-0525

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2008

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