MEDICARE: MS. JOAN IRENE LEPONTOIS 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	149.000910	IL

General Provider Information

NPI Number	:	1740505577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN IRENE LEPONTOIS LCSW

Provider Business Mailing Address
First Line	:	2639 W ESTES AVE APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3225
Country	:	US
Telephone Number	:	773-761-4998
Fax Number	:

Provider Business Practice Location Address
First Line	:	5544 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2217
Country	:	US
Telephone Number	:	773-561-5400
Fax Number	:

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

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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