| NPI | 1174779771 |
|---|---|
| Doing Business As | C.H.A.N.G.E. OF ILLINOIS |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY KENNER WASH Director 708-331-2679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.006944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.106435) |
| 171M00000X Case Manager/Care Coordinator | |
| 208D00000X General Practice (Licence: IL 036.109938) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2008-08-14 |