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General NPI Number Information
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NPI Number | 1528791845
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Entity Type | Organization
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Legal Business Name | RAVENCO INC
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 5115 N RAVENSWOOD AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60640-2712
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Country | US
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Telephone | 312-925-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 N RAVENSWOOD AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60640-2712
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Country | US
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Telephone | 312-925-7800
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Fax |
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Authorized Official
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Title or Position | OWNER, LCSW
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Name | RONALD E PAJAK
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Credential |
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Telephone | 312-925-7800
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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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