=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417492406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRADER VOCATIONAL AND REHABILITATION CONSULTING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2016
-----------------------------------------------------
Last Update Date | 12/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W MAIN ST
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62234-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-346-6641
-----------------------------------------------------
Fax | 618-346-6638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 W MAIN ST
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62234-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-346-6641
-----------------------------------------------------
Fax | 618-346-6638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JACK L. STRADER
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 618-346-6641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------