Healthcare Provider Details

I. General information

NPI: 1093985558
Provider Name (Legal Business Name): WECKLER & ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 AMBROGIO DR SUITE 101
GURNEE IL
60031-3339
US

IV. Provider business mailing address

68 AMBROGIO DR SUITE 101
GURNEE IL
60031-3339
US

V. Phone/Fax

Practice location:
  • Phone: 847-662-5588
  • Fax: 847-662-5875
Mailing address:
  • Phone: 847-662-5588
  • Fax: 847-662-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberA-7505-0002-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberA-7505-0001-A
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-7505-0002-A
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-7505-0001-A
License Number StateIL

VIII. Authorized Official

Name: ROBERT W WECKLER
Title or Position: PRESIDENT
Credential: CSADC, NCACII
Phone: 847-662-5588