Healthcare Provider Details

I. General information

NPI: 1639312580
Provider Name (Legal Business Name): DUI COUNSELING CENTER OF KENDALL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E SOUTH ST
PLANO IL
60545-1417
US

IV. Provider business mailing address

115 E SOUTH ST P O BOX 282
PLANO IL
60545-1417
US

V. Phone/Fax

Practice location:
  • Phone: 630-552-9910
  • Fax: 630-552-9920
Mailing address:
  • Phone: 630-552-9910
  • Fax: 630-552-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA20710016A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberA20710016A
License Number StateIL

VIII. Authorized Official

Name: RON PARTCH JR.
Title or Position: DIRECTOR
Credential: MS, CRADC, SAP
Phone: 630-552-9910