| NPI | 1528432119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH GRANNAN Clinic Director 217-588-7622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103TC0700X Psychologist Clinical | |
| 225XP0200X Occupational Therapist Pediatrics | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |