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General NPI Number Information
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NPI Number | 1679615363
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Entity Type | Organization
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Legal Business Name | JANE ADDAMS COMM MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 300 SUMMIT ST
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City | GALENA
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State | IL
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Zip | 61036-1638
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Country | US
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Telephone | 815-777-2836
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 813 421 W EXCHANGE
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City | FREEPORT
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State | IL
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Zip | 61032-0813
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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 | VP OF PATIENT SERVICES
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Name | KATHRYN MARTINEZ
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Credential |
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Telephone | 815-599-7529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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