Healthcare Provider Details

I. General information

NPI: 1932114758
Provider Name (Legal Business Name): COUNTY OF WILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ELLA AVE
JOLIET IL
60433
US

IV. Provider business mailing address

501 ELLA AVE
JOLIET IL
60433-2799
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-8480
  • Fax: 815-727-8484
Mailing address:
  • Phone: 815-727-8480
  • Fax: 815-727-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: SUSAN OLENEK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 815-727-8485