MEDICARE: BRIDGET CLARE DONNELLY

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	149.027575	IL

General Provider Information

NPI Number	:	1609552256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET CLARE DONNELLY

Provider Business Mailing Address
First Line	:	2015 W DICKENS AVE APT G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4530
Country	:	US
Telephone Number	:	219-728-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 W DICKENS AVE APT G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4530
Country	:	US
Telephone Number	:	219-728-8644
Fax Number	:

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

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	04/29/2026

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