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NPI Code Detail

MEDICARE: DOROTHY RANGE LSW

MEDICARE: DOROTHY RANGE 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
1104100000XSocial Worker150.102117IL

General Provider Information

NPI Number : 1518435817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOROTHY RANGE LSW
Provider Business Mailing Address
First Line : 667 PRIMROSE LN
Second Line :
City : MATTESON
State : IL
Zip : 60443-1762
Country : US
Telephone Number : 708-769-6217
Fax Number :
Provider Business Practice Location Address
First Line : 12145 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-1387
Country : US
Telephone Number : 773-537-3930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2018
Last Update Date : 11/05/2018

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Directions to “ DOROTHY RANGE LSW” Practice Location

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