MEDICARE: MRS. KRISTY LYNN GARRY 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	149015092	IL

General Provider Information

NPI Number	:	1740552256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTY LYNN GARRY LCSW

Provider Business Mailing Address
First Line	:	11130 S 84TH AVE APT 1B
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2419
Country	:	US
Telephone Number	:	708-837-8519
Fax Number	:

Provider Business Practice Location Address
First Line	:	9631 W 153RD ST STE 37
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3778
Country	:	US
Telephone Number	:	708-837-8519
Fax Number	:

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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