| NPI | 1003981192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R BOURBON President 847-918-0129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149007084) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |