MEDICARE: MS. DANIELLE P GLICKLEY 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		IL

General Provider Information

NPI Number	:	1639134224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE P GLICKLEY LSW

Provider Business Mailing Address
First Line	:	7300 W COLLEGE DR
Second Line	:	101
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1152
Country	:	US
Telephone Number	:	708-448-8470
Fax Number	:	708-448-9651

Provider Business Practice Location Address
First Line	:	7300 W COLLEGE DR
Second Line	:	101
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1152
Country	:	US
Telephone Number	:	708-448-8470
Fax Number	:	708-448-9651

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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