| NPI | 1013316470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY BOUCK Lcpc 773-429-9454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: IL 1825273) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |