| NPI | 1649806407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH G. WIERSUM VP Of Finance 847-441-5603 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2020-03-12 |