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General NPI Number Information
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NPI Number | 1386518876
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Entity Type | Organization
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Legal Business Name | AXIAL FROST CLINIC IL, PC
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1615
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City | CHICAGO
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State | IL
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Zip | 60602-1882
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Country | US
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Telephone | 615-345-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 209 10TH AVE S STE 350
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City | NASHVILLE
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State | TN
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Zip | 37203-4166
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Country | US
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Telephone | 615-345-3555
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | ALICE HEYWOOD
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Credential |
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Telephone | 615-231-8560
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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 |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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