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General NPI Number Information
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NPI Number | 1922664598
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Entity Type | Organization
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Legal Business Name | LOOKING GLASS THERAPEUTICS
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Dates
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Enumeration Date | 05/19/2019
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Last Update Date | 05/19/2019
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Provider Practice Location Address
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Address Line | 648 N RIVER RD STE 104
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City | NAPERVILLE
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State | IL
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Zip | 60563-8952
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Country | US
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Telephone | 630-777-7796
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Fax |
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Provider Business Mailing Address
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Address Line | 123 S RUSSELL AVE
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City | AURORA
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State | IL
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Zip | 60506-4947
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Country | US
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Telephone | 630-849-6969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICIAN
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Name | JOSEPH A OLECK
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Credential | LCSW
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Telephone | 630-849-6969
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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 |
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