Healthcare Provider Details

I. General information

NPI: 1073621736
Provider Name (Legal Business Name): VERMILION ASSOC OF SPEC EDUC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15009 CATLIN TILTON RD STE B
DANVILLE IL
61834-5176
US

IV. Provider business mailing address

15009 CATLIN TILTON RD STE B
DANVILLE IL
61834-5176
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-8273
  • Fax: 217-443-0217
Mailing address:
  • Phone: 217-443-8273
  • Fax: 217-443-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA ANN MOORE
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential: MA
Phone: 217-443-8273