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55 E Washington Suite 2700 Chicago IL 60602 | |
| (312) 782-3888 | |
| (312) 782-2901 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 55 E Washington, Chicago, Illinois |
| Authorized Official Name and Position | Jeffrey Joseph Shore (PRESIDENT) |
| Authorized Official Contact | 3127823888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
55 E Washington Suite 2700 Chicago IL 60602 Ph: (312) 782-3888 | 55 E Washington Suite 2700 Chicago IL 60602 Ph: (312) 782-3888 |
| NPI Number | 1720170772 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720170772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Illinois) | Primary |
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