MEDICARE: JEANETTE LEE L.S.W., J.D.

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	150.101937	IL
2	1041C0700X	Clinical Social Worker	149.021344	IL

General Provider Information

NPI Number	:	1851836936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE LEE L.S.W., J.D.

Provider Business Mailing Address
First Line	:	1835 S HAMLIN AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2422
Country	:	US
Telephone Number	:	415-595-0667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 S HAMLIN AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2422
Country	:	US
Telephone Number	:	415-595-0667
Fax Number	:

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

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	08/14/2023

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