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800 Main St Ste 210 Antioch IL 60002-1578 | |
| (847) 903-5604 | |
| (224) 788-5112 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 800 Main St Ste 210, Antioch, Illinois |
| Authorized Official Name and Position | Cherish Reinwald (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8479035604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
800 Main St Ste 210 Antioch IL 60002-1578 Ph: () - | 800 Main St Ste 210 Antioch IL 60002-1578 Ph: (847) 903-5604 |
| NPI Number | 1609365519 |
|---|---|
| Provider Enumeration Date | 05/07/2018 |
| Last Update Date | 06/09/2022 |
| Certification Date | 06/09/2022 |
| Medicare PECOS PAC ID | 8325397375 |
|---|---|
| Medicare Enrollment ID | O20190823001569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609365519 | NPI | - | NPPES |
| 0001609365519 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Megan A Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548421043 PECOS PAC ID: 2365509338 Enrollment ID: I20090318000267 |
| Provider Name | Lashonda K Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447670427 PECOS PAC ID: 8325312986 Enrollment ID: I20170920001190 |
| Provider Name | Grace C Wolbrink |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346527223 PECOS PAC ID: 9739417007 Enrollment ID: I20190823002069 |
| Provider Name | Sally Ann Schulman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164712477 PECOS PAC ID: 3173791464 Enrollment ID: I20191204002174 |
| Provider Name | Wendi Rene Amburgey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427667260 PECOS PAC ID: 7810316171 Enrollment ID: I20201006001674 |
| Provider Name | Michael Andrew Mcwhirter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538759154 PECOS PAC ID: 8123434776 Enrollment ID: I20210308000627 |
| Provider Name | Simone Denise Yancy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780297754 PECOS PAC ID: 3375945405 Enrollment ID: I20210713001299 |
| Provider Name | Darlene Natalie Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720324692 PECOS PAC ID: 2668865064 Enrollment ID: I20220208000323 |
| Provider Name | Audrey Van Oene |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285386326 PECOS PAC ID: 6608964507 Enrollment ID: I20220216000257 |
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