| NPI | 1164806279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MIROCHA Therapist 815-676-4688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149017464) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |