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NPI Code Detail

MEDICARE: DR. JENNIFER ANNE TOLLESON PH.D.

MEDICARE: DR. JENNIFER ANNE TOLLESON PH.D.
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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1548333719
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER ANNE TOLLESON PH.D.
Provider Business Mailing Address
First Line : 3560 N PINE GROVE AVE # 2
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1877
Country : US
Telephone Number : 773-755-6123
Fax Number :
Provider Business Practice Location Address
First Line : 1 E SUPERIOR ST STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2594
Country : US
Telephone Number : 312-409-2851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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