Healthcare Provider Details

I. General information

NPI: 1427524925
Provider Name (Legal Business Name): MORGAN RUDISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 S FRANKFORT SQUARE RD
FRANKFORT IL
60423-9385
US

IV. Provider business mailing address

21000 S FRANKFORT SQUARE RD
FRANKFORT IL
60423-9385
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1500
  • Fax:
Mailing address:
  • Phone: 815-469-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: