MEDICARE: RACHEL MARIE BICKENBACH 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	149011415	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00434457	OTHER	IL	RAILROAD MEDICARE PIN

General Provider Information

NPI Number	:	1811093800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE BICKENBACH LCSW

Provider Business Mailing Address
First Line	:	2750 N RACINE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1206
Country	:	US
Telephone Number	:	773-529-1200
Fax Number	:	773-296-6131

Provider Business Practice Location Address
First Line	:	2750 N RACINE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1206
Country	:	US
Telephone Number	:	773-529-1200
Fax Number	:	773-296-6131

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	09/24/2008

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