| NPI | 1790184182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIA A OGBURN Sole Member 309-682-3915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-008753) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |