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General NPI Number Information
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NPI Number | 1790939577
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC CHANGES, P.C.
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 311 E DICKENS AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-1811
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Country | US
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Telephone | 708-562-0656
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Fax | 708-562-0998
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Provider Business Mailing Address
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Address Line | 311 E DICKENS AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-1811
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Country | US
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Telephone | 708-562-0656
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Fax | 708-562-0998
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHARON J DEPOWSKI
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Credential | MSW, LCSW
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Telephone | 708-562-0656
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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 | 149011315
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License Number State | IL
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