| NPI | 1124379755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE KELLER Director 618-407-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149015007) |
| Enumeration Date | 2012-09-22 |
| Last Update Date | 2018-07-25 |