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NPI Code Detail

MEDICARE: JONATHAN BRADLEY BRODIE LSW

MEDICARE: JONATHAN BRADLEY BRODIE LSW
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
1104100000XSocial Worker150.109498IL

General Provider Information

NPI Number : 1730866674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BRADLEY BRODIE LSW
Provider Business Mailing Address
First Line : 3941 N PINE GROVE AVE APT 310
Second Line :
City : CHICAGO
State : IL
Zip : 60613-3309
Country : US
Telephone Number : 276-618-6517
Fax Number :
Provider Business Practice Location Address
First Line : 180 N MICHIGAN AVE STE 1040
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7421
Country : US
Telephone Number : 312-346-5156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2023
Last Update Date : 07/03/2023

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Directions to “ JONATHAN BRADLEY BRODIE LSW” Practice Location

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