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General NPI Number Information
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NPI Number | 1619758836
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Entity Type | Organization
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Legal Business Name | SPECIALIZED FORENSIC UNIT PC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1005 N WESTERN AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60622-6224
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Country | US
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Telephone | 800-488-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 303 N 2ND ST STE 22
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City | ST CHARLES
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State | IL
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Zip | 60174-1804
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Country | US
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Telephone | 312-818-9300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TETYANA KOSTYSHYNA
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Credential |
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Telephone | 800-488-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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