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NPI Code Detail

MEDICARE: JUSTIN WETTSTEIN MSW, LSW

MEDICARE: JUSTIN WETTSTEIN MSW, 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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598463184
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN WETTSTEIN MSW, LSW
Provider Business Mailing Address
First Line : 2000 N RACINE AVE STE 3300
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7008
Country : US
Telephone Number : 773-413-9523
Fax Number :
Provider Business Practice Location Address
First Line : 4621 N RAVENSWOOD AVE FL 1
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4509
Country : US
Telephone Number : 773-413-9523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2023
Last Update Date : 02/22/2023

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