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General NPI Number Information
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NPI Number | 1992708960
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Entity Type | Organization
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Legal Business Name | EASTER SEALS JOLIET REGION INC.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 212 BARNEY DR
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City | JOLIET
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State | IL
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Zip | 60435-5271
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Country | US
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Telephone | 815-725-2194
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Fax | 815-725-5150
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Provider Business Mailing Address
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Address Line | 212 BARNEY DR
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City | JOLIET
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State | IL
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Zip | 60435-5271
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Country | US
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Telephone | 815-725-2194
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Fax | 815-725-5150
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBBIE CONDOTTI
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Credential | M.A. CRC
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Telephone | 815-725-2194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | CO01038599
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License Number State | IL
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