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General NPI Number Information
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NPI Number | 1316438831
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Entity Type | Organization
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Legal Business Name | COMMUNITY SERVICE COUNCIL OF NORTHERN WILL COUNTY
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 440 QUADRANGLE DR STE C
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3455
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Country | US
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Telephone | 815-886-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 440 QUADRANGLE DR STE C
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3455
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Country | US
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Telephone | 815-886-5000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT KALNICKY
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Credential |
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Telephone | 815-886-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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