Healthcare Provider Details

I. General information

NPI: 1144867854
Provider Name (Legal Business Name): ACORN HEALTH OF ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EAGLE CTR STE 1
O FALLON IL
62269-1945
US

IV. Provider business mailing address

1500 S DOUGLAS RD # 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 618-206-8816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KAREN ARTEAGA
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 844-244-1818