MEDICARE: ASHLEE NICOLE TAYLOR 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
1	104100000X	Social Worker		IL

General Provider Information

NPI Number	:	1750054433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE NICOLE TAYLOR LSW

Provider Business Mailing Address
First Line	:	215 W WASHINGTON ST APT 3107
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-3516
Country	:	US
Telephone Number	:	708-214-4302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W JACKSON BLVD STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2847
Country	:	US
Telephone Number	:	312-563-6651
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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