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General NPI Number Information
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NPI Number | 1568882504
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Entity Type | Organization
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Legal Business Name | CLEARBROOK
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1425 PAYNE RD
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4513
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Country | US
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Telephone | 847-310-9141
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 PAYNE RD
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4513
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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 | DIRECTOR OF CLINICAL SERVICES
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Name | MARK AMMER
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Credential |
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Telephone | 847-310-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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