MEDICARE: MRS. JOAN MATTHEWS MS

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	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1730213174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN MATTHEWS MS

Provider Business Mailing Address
First Line	:	9343 S RIDGELAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3637
Country	:	US
Telephone Number	:	773-221-9024
Fax Number	:	773-221-8006

Provider Business Practice Location Address
First Line	:	9343 S RIDGELAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3637
Country	:	US
Telephone Number	:	773-221-9024
Fax Number	:	773-221-8006

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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