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General NPI Number Information
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NPI Number | 1295999340
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD CENTER
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 529 COTTONWOOD RD
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City | FRANKFORT
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State | IL
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Zip | 60423-1009
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Country | US
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Telephone | 815-806-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 529 COTTONWOOD RD
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City | FRANKFORT
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State | IL
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Zip | 60423-1009
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Country | US
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Telephone | 815-806-0307
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Fax |
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | MRS. MARY J GUYMON
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Credential | DT
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Telephone | 815-806-0307
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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 | 252Y00000X
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License Number State | IL
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