| NPI | 1154652147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN A SMITH Clinician 815-285-3073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149010806) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |