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General NPI Number Information
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NPI Number | 1730578485
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Entity Type | Organization
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Legal Business Name | NICOLETTE KOMIE AND ASSOCIATES
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 10 W PHILLIP RD SUITE 103
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City | VERNON HILLS
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State | IL
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Zip | 60061-1799
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Country | US
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Telephone | 847-275-4115
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Fax | 847-868-9222
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Provider Business Mailing Address
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Address Line | 10 W PHILLIP RD SUITE 103
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City | VERNON HILLS
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State | IL
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Zip | 60061-1799
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Country | US
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Telephone | 847-275-4115
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Fax | 847-868-9222
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST/OWNER
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Name | NICOLETTE KOMIE
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Credential |
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Telephone | 847-275-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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