MEDICARE: MS. JOANNE SIMON KESTNBAUM 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	149-001566	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149-001566	OTHER	IL	STATE LICENSURE

General Provider Information

NPI Number	:	1710996053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNE SIMON KESTNBAUM LCSW

Provider Business Mailing Address
First Line	:	9021 LINCOLNWOOD DR
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60203-1824
Country	:	US
Telephone Number	:	847-899-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 OLD ORCHARD RD STE 29
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1027
Country	:	US
Telephone Number	:	847-899-2911
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/24/2019

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