MEDICARE: BROOKE REAMS 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	150.115934	IL

General Provider Information

NPI Number	:	1679382741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE REAMS LSW

Provider Business Mailing Address
First Line	:	1317 W GREENLEAF AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-2962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2745 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2342
Country	:	US
Telephone Number	:	602-206-4328
Fax Number	:

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

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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Directions to “ BROOKE REAMS LSW” Practice Location

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