| NPI | 1285800581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER SMITH Credentialing Agent 815-965-8505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149001649) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |