Healthcare Provider Details

I. General information

NPI: 1588334213
Provider Name (Legal Business Name): PLK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N WESTSHORE DR APT 701
CHICAGO IL
60601-7232
US

IV. Provider business mailing address

201 N WESTSHORE DR APT 701
CHICAGO IL
60601-7232
US

V. Phone/Fax

Practice location:
  • Phone: 610-608-1742
  • Fax:
Mailing address:
  • Phone: 610-608-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PEGGY L KEPPLE
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 610-608-1742