Healthcare Provider Details

I. General information

NPI: 1992708960
Provider Name (Legal Business Name): EASTER SEALS JOLIET REGION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BARNEY DR
JOLIET IL
60435-5271
US

IV. Provider business mailing address

212 BARNEY DR
JOLIET IL
60435-5271
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-2194
  • Fax: 815-725-5150
Mailing address:
  • Phone: 815-725-2194
  • Fax: 815-725-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberCO01038599
License Number StateIL

VIII. Authorized Official

Name: MS. DEBBIE CONDOTTI
Title or Position: PRESIDENT
Credential: M.A. CRC
Phone: 815-725-2194