| NPI | 1639745912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL PUETZ Managed Care Contracting Manager 847-306-3917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 235Z00000X Speech-Language Pathologist, | |
| 1041C0700X Social Worker, Clinical | |
| 106E00000X Assistant Behavior Analyst | |
| 106H00000X Marriage & Family Therapist | |
| 106S00000X Behavior Technician | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |