MEDICARE: JANICE FLECKMAN 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	149000700	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01606364	OTHER	IL	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1720002488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE FLECKMAN LCSW

Provider Business Mailing Address
First Line	:	5225 OLD ORCHARD RD STE 1
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1027
Country	:	US
Telephone Number	:	847-328-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 OLD ORCHARD RD STE 1
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1027
Country	:	US
Telephone Number	:	847-328-1688
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/22/2009

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