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NPI Code Detail

MEDICARE: ERIN TINNON MSW, LCSW

MEDICARE: ERIN TINNON MSW, 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
11041C0700XClinical Social Worker150.101728IL

General Provider Information

NPI Number : 1912359274
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN TINNON MSW, LCSW
Provider Business Mailing Address
First Line : 4707 N BROADWAY ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4999
Country : US
Telephone Number : 773-796-5987
Fax Number : 773-796-3509
Provider Business Practice Location Address
First Line : 4707 N BROADWAY ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4999
Country : US
Telephone Number : 773-796-5987
Fax Number : 773-796-3509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2016
Last Update Date : 08/12/2019

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