Healthcare Provider Details

I. General information

NPI: 1497889687
Provider Name (Legal Business Name): INDIAN SPRINGS SCH DIST 109
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 SOUTH 86TH AVE
JUSTICE IL
60458
US

IV. Provider business mailing address

7540 SOUTH 86TH AVE
JUSTICE IL
60458
US

V. Phone/Fax

Practice location:
  • Phone: 708-496-8700
  • Fax: 708-496-8641
Mailing address:
  • Phone: 708-496-8700
  • Fax: 708-496-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA JEFFERS
Title or Position: MANAGER
Credential:
Phone: 708-496-8700