Healthcare Provider Details

I. General information

NPI: 1396566501
Provider Name (Legal Business Name): INTERESSE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 AUGUSTA ST
OAK PARK IL
60302
US

IV. Provider business mailing address

805 LAKE ST # 227
OAK PARK IL
60301-1301
US

V. Phone/Fax

Practice location:
  • Phone: 608-618-3823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY L DUNGY-AKENJI
Title or Position: OWNER
Credential: LCSW
Phone: 608-618-3823