MEDICARE: WILL PHILLIPS 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
1	1041C0700X	Clinical Social Worker	149010734	IL
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1972877561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILL PHILLIPS LCSW

Provider Business Mailing Address
First Line	:	3304 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3517
Country	:	US
Telephone Number	:	773-413-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3517
Country	:	US
Telephone Number	:	773-413-8521
Fax Number	:

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

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	12/01/2014

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Directions to “ WILL PHILLIPS LCSW” Practice Location

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