MEDICARE: COLLEEN MANUEL KEMPNER MSW, MA, 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
1	104100000X	Social Worker	150.015780	IL
2	1041C0700X	Clinical Social Worker	149.019124	IL

General Provider Information

NPI Number	:	1629420112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MANUEL KEMPNER MSW, MA, LSW

Provider Business Mailing Address
First Line	:	2525 W FARRAGUT AVE
Second Line	:	2W
City	:	CHICAGO
State	:	IL
Zip	:	60625-2442
Country	:	US
Telephone Number	:	952-564-4304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 W FARRAGUT AVE
Second Line	:	2W
City	:	CHICAGO
State	:	IL
Zip	:	60625-2442
Country	:	US
Telephone Number	:	952-564-4304
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	04/26/2017

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