Healthcare Provider Details

I. General information

NPI: 1811667710
Provider Name (Legal Business Name): TAKING CONTROL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S LINCOLNWAY STE F
NORTH AURORA IL
60542-1597
US

IV. Provider business mailing address

106 S LINCOLNWAY STE F
NORTH AURORA IL
60542-1597
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-1669
  • Fax: 630-801-1675
Mailing address:
  • Phone: 630-801-1669
  • Fax: 630-801-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN RAMSEYJORGENSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 630-801-1669