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NPI Code Detail

MEDICARE: INDEPENDENCE HEALTH & THERAPY

MEDICARE: INDEPENDENCE HEALTH & THERAPY
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
1261QA0600XAdult Day Care Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)IL

General Provider Information

NPI Number : 1598717597
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENCE HEALTH & THERAPY
Provider Business Mailing Address
First Line : 2028 N SEMINARY AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-2626
Country : US
Telephone Number : 815-338-3590
Fax Number : 815-337-4406
Provider Business Practice Location Address
First Line : 2028 N SEMINARY AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-2626
Country : US
Telephone Number : 815-338-3590
Fax Number : 815-337-4406
Authorized Official
Title or Position : FINANCE DIRECTOR
Name : MARY FISHER
Credential :
Telephone Number : 815-338-3590
Provider Enumeration Date : 05/17/2006
Last Update Date : 04/27/2023

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Practice Location Address:
2028 N SEMINARY AVE
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60098-2626
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Practice Fax:
1992956619 — MRS. NICOLE SUZANNE O'DEA LCSW
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1548687817 — JACLYN KROEGER LCSW
Practice Location Address:
2028 N SEMINARY AVE
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60098-2626
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1346638921 — LINDA STRUEBER LCSW
Practice Location Address:
2028 N SEMINARY AVE
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60098-2626
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Directions to “INDEPENDENCE HEALTH & THERAPY ” Practice Location

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