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 |