MEDICARE: YAEJI LEE MSW

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		IL

General Provider Information

NPI Number	:	1932898558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAEJI LEE MSW

Provider Business Mailing Address
First Line	:	2155 N ELSTON AVE APT 669
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0052
Country	:	US
Telephone Number	:	832-367-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-1544
Country	:	US
Telephone Number	:	773-687-9241
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	06/16/2026

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