| NPI | 1548658222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA TADLOCK Owner 847-490-1820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-005963) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2015-01-02 |