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NPI Code Detail

MEDICARE: MRS. CARRIE ELIZABETH OHL L.C.S.W

MEDICARE: MRS. CARRIE ELIZABETH OHL L.C.S.W
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 Worker61516TX
21041C0700XClinical Social Worker149.017299IL

General Provider Information

NPI Number : 1912363672
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARRIE ELIZABETH OHL L.C.S.W
Provider Business Mailing Address
First Line : 3436 N HOYNE AVE
Second Line : APT #1
City : CHICAGO
State : IL
Zip : 60618-6147
Country : US
Telephone Number : 630-853-4585
Fax Number :
Provider Business Practice Location Address
First Line : 2600 RIDGELAND AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-2725
Country : US
Telephone Number : 708-317-5926
Fax Number : 708-637-4316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2016
Last Update Date : 01/11/2016

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