MEDICARE: IN2GREAT

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	1041C0700X	Clinical Social Worker
2	225100000X	Physical Therapist
3	103K00000X	Behavior Analyst
4	104100000X	Social Worker
5	235Z00000X	Speech-Language Pathologist
6	225X00000X	Occupational Therapist	056007610	IL

General Provider Information

NPI Number	:	1629329172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN2GREAT

Provider Business Mailing Address
First Line	:	1371 ABBOTT CT
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2367
Country	:	US
Telephone Number	:	847-409-8015
Fax Number	:	847-947-2890

Provider Business Practice Location Address
First Line	:	1371 ABBOTT CT
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2367
Country	:	US
Telephone Number	:	847-777-8995
Fax Number	:	847-947-2890

Authorized Official
Title or Position	:	OWNER
Name	:	EVANGELIA HARISIADIS
Credential	:
Telephone Number	:	847-777-8995

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	08/08/2024

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Directions to “IN2GREAT ” Practice Location

Language	Start Address	Practice Location

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