Intensive Out-patient Care | |
156 N Main St Suite 202 Edwardsville IL 62025-1972 | |
(618) 656-7064 | |
(618) 656-9084 |
Full Name | Intensive Out-patient Care |
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Speciality | Social Worker - Clinical |
Location | 156 N Main St, Edwardsville, Illinois |
Authorized Official Name and Position | Jennifer Mary Manning (PROGRAM DIRECTOR) |
Authorized Official Contact | 6186567064 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Intensive Out-patient Care 156 N Main St Suite 202 Edwardsville IL 62025-1972 Ph: (618) 656-7064 | Intensive Out-patient Care 156 N Main St Suite 202 Edwardsville IL 62025-1972 Ph: (618) 656-7064 |
NPI Number | 1477685527 |
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Provider Enumeration Date | 03/12/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1477685527 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (Illinois) | Primary |
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