| NPI | 1275548968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE ANN LOGAN Co Owner 815-316-2621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149011421) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2008-02-15 |