MEDICARE: MRS. DANA PLOUS 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	149013047	IL

General Provider Information

NPI Number	:	1639414519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA PLOUS LCSW

Provider Business Mailing Address
First Line	:	2331 N LISTER AVE
Second Line	:	UNIT F
City	:	CHICAGO
State	:	IL
Zip	:	60614-2965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5712
Country	:	US
Telephone Number	:	312-545-9212
Fax Number	:

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	07/28/2014

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