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General NPI Number Information
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NPI Number | 1144513938
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Entity Type | Organization
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Legal Business Name | CHANNAHON DUI SERVICES, LLC
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 23157 THOMAS DILLON DRIVE
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City | CHANNAHON
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State | IL
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Zip | 60410
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Country | US
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Telephone | 815-210-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 23157 THOMAS DILLON DRIVE
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City | CHANNAHON
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State | IL
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Zip | 60410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ASSESSOR
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Name | MISS GABRIELA OROZCO
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Credential | CADC
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Telephone | 815-210-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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