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General NPI Number Information
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NPI Number | 1306384284
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Entity Type | Organization
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Legal Business Name | AGRUSS CENTER FOR HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 1100 LAKE ST SUITE 201
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City | OAK PARK
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State | IL
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Zip | 60301-1015
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Country | US
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Telephone | 630-686-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 2852 W ROSEMONT AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60659-1621
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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 | OWNER/THERAPIST
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Name | SUSAN AGRUSS
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Credential |
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Telephone | 630-686-2019
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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 | 149014213
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License Number State | IL
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