| NPI | 1922696319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA KRUEGER Licensed Clinical Social Worker 217-257-2849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-01-02 |
| Last Update Date | 2021-01-02 |