Healthcare Provider Details

I. General information

NPI: 1184843724
Provider Name (Legal Business Name): CREATIVE EXCHANGE MUSIC THERAPY CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 WESTCHESTER BLVD SUITE ONE SOUTH
WESTCHESTER IL
60154-3644
US

IV. Provider business mailing address

1527 WESTCHESTER BLVD SUITE ONE SOUTH
WESTCHESTER IL
60154-3644
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-6100
  • Fax:
Mailing address:
  • Phone: 708-345-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: KARI D CHRISTIANSEN
Title or Position: DIRECTOR
Credential:
Phone: 708-345-6100