| Jodi Knox-holub Llc | |
|
3576 Court St Pekin IL 61554-6211 | |
| (309) 231-7407 | |
| Not Available |
| Full Name | Jodi Knox-holub Llc |
|---|---|
| Speciality | Counselor |
| Location | 3576 Court St, Pekin, Illinois |
| Authorized Official Name and Position | Jodi Knox-holub (OWNER) |
| Authorized Official Contact | 3092317407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jodi Knox-holub Llc 3576 Court St Pekin IL 61554-6211 Ph: (309) 231-7407 | Jodi Knox-holub Llc 3576 Court St Pekin IL 61554-6211 Ph: (309) 231-7407 |
| NPI Number | 1558707745 |
|---|---|
| Provider Enumeration Date | 05/15/2013 |
| Last Update Date | 10/16/2023 |
| Certification Date | 10/16/2023 |
| Medicare PECOS PAC ID | 5294172169 |
|---|---|
| Medicare Enrollment ID | O20240327002273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558707745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jodi Deeann Knox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841594462 PECOS PAC ID: 0648617514 Enrollment ID: I20240327002345 |
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