| NPI | 1063185114 |
|---|---|
| Former Legal Business Name | JENNIFER MORENO |
| Entity Type | Organization |
| Authorized Contact | JENNIFER MORENO Executive Director 815-782-2172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2023-09-06 |