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NPI Code Detail

MEDICARE: EASTER SEALS JOLIET REGION INC.

MEDICARE: EASTER SEALS JOLIET REGION INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD1600XDevelopmental Disabilities Clinic/CenterCO01038599IL

General Provider Information

NPI Number : 1992708960
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS JOLIET REGION INC.
Provider Business Mailing Address
First Line : 212 BARNEY DR
Second Line :
City : JOLIET
State : IL
Zip : 60435-5271
Country : US
Telephone Number : 815-725-2194
Fax Number : 815-725-5150
Provider Business Practice Location Address
First Line : 212 BARNEY DR
Second Line :
City : JOLIET
State : IL
Zip : 60435-5271
Country : US
Telephone Number : 815-725-2194
Fax Number : 815-725-5150
Authorized Official
Title or Position : PRESIDENT
Name : MS. DEBBIE CONDOTTI
Credential : M.A. CRC
Telephone Number : 815-725-2194
Provider Enumeration Date : 05/24/2005
Last Update Date : 06/17/2008

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Directions to “EASTER SEALS JOLIET REGION INC. ” Practice Location

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