| NPI | 1629463641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY C FAIRCHILD Owner 815-520-6676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.010948) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-08 |