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General NPI Number Information
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NPI Number | 1225392798
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Entity Type | Organization
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Legal Business Name | JORI RISKE LCSW, LTD.
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 209 E PARK ST SUITE B
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City | MUNDELEIN
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State | IL
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Zip | 60060-1972
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Country | US
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Telephone | 224-360-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E PARK ST SUITE B
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City | MUNDELEIN
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State | IL
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Zip | 60060-1972
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Country | US
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Telephone | 224-360-0688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JORI RISKE
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Credential | LCSW
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Telephone | 847-489-7282
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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 | 149008638
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License Number State | IL
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