Healthcare Provider Details

I. General information

NPI: 1528532785
Provider Name (Legal Business Name): AKSPAINLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S EAST AVE UNIT 1
OAK PARK IL
60302-3211
US

IV. Provider business mailing address

245 S EAST AVE UNIT 1
OAK PARK IL
60302-3211
US

V. Phone/Fax

Practice location:
  • Phone: 630-240-1182
  • Fax:
Mailing address:
  • Phone: 630-240-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANURADHA SPAIN
Title or Position: OWNER
Credential: MA LCSW
Phone: 630-240-1182