MEDICARE: MRS. VICTORIA MYHRE 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	149.025492	IL

General Provider Information

NPI Number	:	1750077343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA MYHRE LCSW

Provider Business Mailing Address
First Line	:	12466 KINZIE LN
Second Line	:
City	:	HUNTLEY
State	:	IL
Zip	:	60142-7052
Country	:	US
Telephone Number	:	630-363-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 CRYSTAL LAKE RD STE 140
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-1254
Country	:	US
Telephone Number	:	224-456-9356
Fax Number	:

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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