| NPI | 1750446373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA R OBRIEN Community Services Manager 815-288-6691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 251B00000X Case Management | |
| 251C00000X | |
| 222Q00000X Developmental Therapist | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071007493) | |
| 225X00000X Occupational Therapist (Licence: IL 056005546) | |
| 235Z00000X Speech-Language Pathologist, (Licence: IL 14600657) | |
| 235Z00000X Speech-Language Pathologist, (Licence: IL 146008250) | |
| 225100000X Physical Therapist (Licence: IL 070002814) | |
| 225X00000X Occupational Therapist (Licence: IL 056006700) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2016-08-22 |