Healthcare Provider Details

I. General information

NPI: 1922564970
Provider Name (Legal Business Name): STICKNEY PUBLIC HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 STATE ROAD
BURBANK IL
60459-2051
US

IV. Provider business mailing address

5635 STATE RD
BURBANK IL
60459-2051
US

V. Phone/Fax

Practice location:
  • Phone: 708-237-8918
  • Fax: 708-237-8997
Mailing address:
  • Phone: 708-237-8918
  • Fax: 708-237-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER GRUNOW
Title or Position: HEALTH DIRECTOR
Credential: PSY.D
Phone: 708-424-9200