MEDICARE: MS. JENNIFER MEADE MAGRUDER 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	149011447	IL

General Provider Information

NPI Number	:	1548421126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MEADE MAGRUDER LCSW

Provider Business Mailing Address
First Line	:	2202 W 107TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3120
Country	:	US
Telephone Number	:	773-880-4882
Fax Number	:	773-880-8314

Provider Business Practice Location Address
First Line	:	2515 N CLARK ST
Second Line	:	8TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60614-2730
Country	:	US
Telephone Number	:	773-880-4882
Fax Number	:	773-880-8314

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/18/2008

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