MEDICARE: MS. KRISTIN J.N. CHAE MSW, 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	149013459	IL

General Provider Information

NPI Number	:	1700026820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN J.N. CHAE MSW, LCSW

Provider Business Mailing Address
First Line	:	4256 N RAVENSWOOD AVE
Second Line	:	SUITE 212
City	:	CHICAGO
State	:	IL
Zip	:	60613-1110
Country	:	US
Telephone Number	:	312-880-9429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4256 N RAVENSWOOD AVE
Second Line	:	SUITE 212
City	:	CHICAGO
State	:	IL
Zip	:	60613-1110
Country	:	US
Telephone Number	:	312-880-9429
Fax Number	:

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	04/02/2013

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