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NPI Code Detail

MEDICARE: PETER ILLING LCSW

MEDICARE: PETER ILLING 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 Worker149-004066IL

General Provider Information

NPI Number : 1922201813
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER ILLING LCSW
Provider Business Mailing Address
First Line : 4101 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2193
Country : US
Telephone Number : 773-572-5500
Fax Number :
Provider Business Practice Location Address
First Line : 4101 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2193
Country : US
Telephone Number : 773-572-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2007
Last Update Date : 09/01/2011

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Directions to “ PETER ILLING LCSW” Practice Location

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