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General NPI Number Information
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NPI Number | 1033387261
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Entity Type | Organization
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Legal Business Name | CLINICAL EXPRESSIONS
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 155 N WACKER DR STE 4250
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City | CHICAGO
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State | IL
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Zip | 60606-1750
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Country | US
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Telephone | 312-262-5387
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 FAIRFAX CIR E UNIT B2
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City | BARTLETT
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State | IL
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Zip | 60103-7484
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Country | US
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Telephone | 815-901-3769
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | DR. ERICA WADE
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Credential | PH.D., LCPC, ACS
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Telephone | 815-901-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180006666
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License Number State | IL
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