| NPI | 1720598402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY KAY JOHNSON Office Manager 815-988-0389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149019739) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-10-10 |