| Glastonbury Place Llc | |
|
123 W Washington St Ste 325 Oswego IL 60543-8254 | |
| (815) 290-9746 | |
| Not Available |
| Full Name | Glastonbury Place Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 123 W Washington St Ste 325, Oswego, Illinois |
| Authorized Official Name and Position | Amy Gillette (OWNER) |
| Authorized Official Contact | 8152909746 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glastonbury Place Llc 123 W Washington St Ste 325 Oswego IL 60543-8254 Ph: (815) 290-9746 | Glastonbury Place Llc 123 W Washington St Ste 325 Oswego IL 60543-8254 Ph: (815) 290-9746 |
| NPI Number | 1871228593 |
|---|---|
| Provider Enumeration Date | 07/18/2022 |
| Last Update Date | 08/17/2022 |
| Certification Date | 08/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871228593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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