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106 N Main St Decatur IL 62523-1207 | |
| (217) 330-6282 | |
| (217) 481-8701 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 106 N Main St, Decatur, Illinois |
| Authorized Official Name and Position | Heather Michelle Kaloupek (OWNER) |
| Authorized Official Contact | 2173306282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
106 N Main St Decatur IL 62523-1207 Ph: (217) 330-6282 | 106 N Main St Decatur IL 62523-1207 Ph: (217) 330-6282 |
| NPI Number | 1669012753 |
|---|---|
| Provider Enumeration Date | 01/07/2020 |
| Last Update Date | 09/09/2021 |
| Certification Date | 09/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669012753 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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