MEDICARE: ELIZABETH ANNE BOWEN MA, 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		IL

General Provider Information

NPI Number	:	1609094796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE BOWEN MA, LCSW

Provider Business Mailing Address
First Line	:	4411 N RAVENSWOOD AVE
Second Line	:	3RD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-751-4012
Fax Number	:	773-989-1935

Provider Business Practice Location Address
First Line	:	4411 N RAVENSWOOD AVE
Second Line	:	3RD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-751-4012
Fax Number	:	773-989-1935

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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