| Crawford Avenue Group Inc | |
|
2530 Crawford Ave Ste 206 Evanston IL 60201-4959 | |
| (847) 875-4411 | |
| Not Available |
| Full Name | Crawford Avenue Group Inc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2530 Crawford Ave Ste 206, Evanston, Illinois |
| Authorized Official Name and Position | Kelli Klinger (PRESIDENT) |
| Authorized Official Contact | 8478754411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crawford Avenue Group Inc 2530 Crawford Ave Ste 206 Evanston IL 60201-4959 Ph: () - | Crawford Avenue Group Inc 2530 Crawford Ave Ste 206 Evanston IL 60201-4959 Ph: (847) 875-4411 |
| NPI Number | 1013409366 |
|---|---|
| Provider Enumeration Date | 06/02/2018 |
| Last Update Date | 06/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013409366 | NPI | - | NPPES |
| 0000603083 | Other | IL | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| 1619019080 | Other | IL | TYPE 1-NPI |
| 1891819363 | Other | IL | TYPE 1-NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071007124 (Illinois) | Primary |
| 1041C0700X | Social Worker - Clinical | 149003065 (Illinois) | Secondary |
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