| Bold Spark, Inc. | |
|
820 S Bartlett Rd Ste 106b Streamwood IL 60107-2407 | |
| (224) 318-7554 | |
| Not Available |
| Full Name | Bold Spark, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 820 S Bartlett Rd Ste 106b, Streamwood, Illinois |
| Authorized Official Name and Position | Karen V. Liebold (OWNER) |
| Authorized Official Contact | 6303296709 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bold Spark, Inc. 218 Gingerbrook Ln Bartlett IL 60103-4624 Ph: (630) 329-6709 | Bold Spark, Inc. 820 S Bartlett Rd Ste 106b Streamwood IL 60107-2407 Ph: (224) 318-7554 |
| NPI Number | 1043072218 |
|---|---|
| Provider Enumeration Date | 01/24/2024 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043072218 | NPI | - | NPPES |
| 1245414465 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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