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General NPI Number Information
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NPI Number | 1174659924
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Entity Type | Organization
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Legal Business Name | MUDDWORKS, INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708 CHURCH ST SUITE 258
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 847-332-2589
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Fax | 847-332-2609
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Provider Business Mailing Address
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Address Line | 708 CHURCH ST SUITE 258
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 847-332-2589
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Fax | 847-332-2609
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER MICHAEL MUDD
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Credential |
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Telephone | 847-332-2589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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