MEDICARE: WHOLE FAMILY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	149012783	IL

General Provider Information

NPI Number	:	1548534829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE FAMILY, INC

Provider Business Mailing Address
First Line	:	1655 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1043
Country	:	US
Telephone Number	:	312-519-3187
Fax Number	:	773-880-1315

Provider Business Practice Location Address
First Line	:	1655 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1043
Country	:	US
Telephone Number	:	312-519-3187
Fax Number	:	773-880-1315

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SARAH C. WATKIN
Credential	:	LCSW
Telephone Number	:	312-519-3187

Provider Enumeration Date	:	03/03/2012
Last Update Date	:	03/03/2012

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