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NPI Code Detail

MEDICARE: MAXWELL WOLCOTT

MEDICARE: MAXWELL WOLCOTT
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 Worker150.102023IL

General Provider Information

NPI Number : 1790234292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXWELL WOLCOTT
Provider Business Mailing Address
First Line : 2439 N MOZART ST
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2613
Country : US
Telephone Number : 301-717-9173
Fax Number :
Provider Business Practice Location Address
First Line : 1800 RAVINIA PL
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3761
Country : US
Telephone Number : 301-717-9173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2016
Last Update Date : 09/25/2016

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Directions to “ MAXWELL WOLCOTT ” Practice Location

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