| NPI | 1255453056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN BENEVIDES Billing Supervisor 815-725-6511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2009-04-28 |