| NPI | 1629868641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL VICK CFO 815-387-5642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist | |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-05-12 |