Healthcare Provider Details

I. General information

NPI: 1154393494
Provider Name (Legal Business Name): THERAPEUTIC LINKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COMMERCE DR SUITE 109
GRAYSLAKE IL
60030-7807
US

IV. Provider business mailing address

15 COMMERCE DR SUITE 109
GRAYSLAKE IL
60030-7807
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-3458
  • Fax: 847-548-3459
Mailing address:
  • Phone: 847-548-3458
  • Fax: 847-548-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number056-005-352
License Number StateIL

VIII. Authorized Official

Name: TRACY LYNDON
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 847-548-3458