| NPI | 1346790169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULLIE KRISTINE WALLENDA Cota/L 815-462-4928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: IL 057.002258) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |