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NPI Code Detail

MEDICARE: ABIGAIL ANN MAXWELL

MEDICARE: ABIGAIL ANN MAXWELL
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 Worker149013058IL

General Provider Information

NPI Number : 1598926578
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL ANN MAXWELL
Provider Business Mailing Address
First Line : 318 6TH AVE
Second Line : UNIT 2
City : ROCHELLE
State : IL
Zip : 61068-1635
Country : US
Telephone Number : 630-975-1097
Fax Number :
Provider Business Practice Location Address
First Line : 1321 N 7TH ST
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-1185
Country : US
Telephone Number : 815-562-3801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2008
Last Update Date : 06/23/2008

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