| NPI | 1174035612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA VITULLO Director Of Payer Operation 815-735-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2024-10-18 |