Healthcare Provider Details

I. General information

NPI: 1033526967
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 N VETERANS PKWY SUITE 3-A
BLOOMINGTON IL
61704-6426
US

IV. Provider business mailing address

17 N STATE ST STE 500
CHICAGO IL
60602-3384
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-4014
  • Fax: 309-828-6309
Mailing address:
  • Phone: 312-592-6800
  • Fax: 312-592-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIKA R GONZALEZ
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 312-592-6892