| NPI | 1083664510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA KUBA Billing Manager 708-845-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-09-25 |