MEDICARE: MRS. AUDREY J GUIDARELLI 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		IL

General Provider Information

NPI Number	:	1700915444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDREY J GUIDARELLI LCSW

Provider Business Mailing Address
First Line	:	8847 KILPATRICK AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1825
Country	:	US
Telephone Number	:	847-674-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 N HARLEM AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4714
Country	:	US
Telephone Number	:	708-867-6886
Fax Number	:	708-867-0207

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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