MEDICARE: ALEXANDRA LEE THOMPSON 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	149.019088	IL

General Provider Information

NPI Number	:	1730675182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LEE THOMPSON LCSW

Provider Business Mailing Address
First Line	:	420 LAKE COOK RD STE 113
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 LAKE COOK ROAD
Second Line	:	SUITE 113
City	:	DEERFIELD
State	:	IL
Zip	:	60015
Country	:	US
Telephone Number	:	847-323-8189
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	12/09/2025

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