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General NPI Number Information
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NPI Number | 1912917725
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Entity Type | Organization
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Legal Business Name | CISCO THERAPEUTIC SERVICES, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1520 N ROCK RUN DR SUITE 30A
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City | CREST HILL
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State | IL
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Zip | 60435-3153
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Country | US
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Telephone | 815-741-3009
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Fax | 815-741-8322
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Provider Business Mailing Address
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Address Line | 1520 N ROCK RUN DR SUITE 30A
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City | CREST HILL
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State | IL
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Zip | 60435-3153
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Country | US
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Telephone | 815-741-3009
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Fax | 815-741-8322
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Authorized Official
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Title or Position | OWNER
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Name | MS. KRIS CISCO
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Credential | LCSW
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Telephone | 815-741-3009
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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 |
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License Number State | IL
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