| NPI | 1114464781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHARINE ANN FAGAN-NELSON Licensced Clinical Social Worker 309-826-3566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149009316) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-01-20 |