| NPI | 1104171917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ROBERTA DAVIS President 847-502-1007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: IL 180.007623) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 222Q00000X Developmental Therapist | |
| 251S00000X Community/Behavioral Health (Licence: IL 180.007623) | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2025-03-12 |