Healthcare Provider Details

I. General information

NPI: 1376033241
Provider Name (Legal Business Name): MARIA K RIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N STATE ST
ELGIN IL
60123-1404
US

IV. Provider business mailing address

115 PRAIRIE PARK DR APT 306
WHEELING IL
60090-2019
US

V. Phone/Fax

Practice location:
  • Phone: 847-628-2464
  • Fax:
Mailing address:
  • Phone: 847-224-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014091
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: