Healthcare Provider Details

I. General information

NPI: 1730598848
Provider Name (Legal Business Name): COMPASSIONATE EDGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 PARK ST STE 190
NAPERVILLE IL
60563-4864
US

IV. Provider business mailing address

1717 PARK ST STE 190
NAPERVILLE IL
60563-4864
US

V. Phone/Fax

Practice location:
  • Phone: 331-444-2618
  • Fax:
Mailing address:
  • Phone: 331-444-2618
  • Fax: 844-802-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007828
License Number StateIL

VIII. Authorized Official

Name: REGINA ROGERS
Title or Position: PRESIDENT
Credential: LCPC
Phone: 331-444-2618