| Ccl Therapeutic Services, Inc. | |
|
9620 Us Route 34 Suite E Yorkville IL 60560-1394 | |
| (630) 688-0289 | |
| Not Available |
| Full Name | Ccl Therapeutic Services, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 9620 Us Route 34, Yorkville, Illinois |
| Authorized Official Name and Position | Colleen Clark Lay (PRESIDENT) |
| Authorized Official Contact | 6306880289 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccl Therapeutic Services, Inc. 9620 Us Route 34 Suite E Yorkville IL 60560-1394 Ph: (630) 688-0289 | Ccl Therapeutic Services, Inc. 9620 Us Route 34 Suite E Yorkville IL 60560-1394 Ph: (630) 688-0289 |
| NPI Number | 1619182557 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 10/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619182557 | NPI | - | NPPES |
| 149010985 | Other | IL | STATE CLINICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149010985 (Illinois) | Primary |
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