Healthcare Provider Details

I. General information

NPI: 1366625741
Provider Name (Legal Business Name): MRS. SOFIA FORKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 12/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 S MCLEAN BLVD
ELGIN IL
60123-6704
US

IV. Provider business mailing address

799 S MCLEAN BLVD
ELGIN IL
60123-6704
US

V. Phone/Fax

Practice location:
  • Phone: 847-499-9207
  • Fax: 847-488-9209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: