Healthcare Provider Details

I. General information

NPI: 1629329172
Provider Name (Legal Business Name): IN2GREAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 ABBOTT CT
BUFFALO GROVE IL
60089-2367
US

IV. Provider business mailing address

1371 ABBOTT CT
BUFFALO GROVE IL
60089-2367
US

V. Phone/Fax

Practice location:
  • Phone: 847-777-8995
  • Fax: 847-947-2890
Mailing address:
  • Phone: 847-409-8015
  • Fax: 847-947-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056007610
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: EVANGELIA HARISIADIS
Title or Position: OWNER
Credential:
Phone: 847-777-8995