| Mizani Therapeutic Services, Llc | |
|
2501 Chatham Rd # 5051 Springfield IL 62704-4188 | |
| (773) 916-6513 | |
| Not Available |
| Full Name | Mizani Therapeutic Services, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2501 Chatham Rd # 5051, Springfield, Illinois |
| Authorized Official Name and Position | Chloe S. Glispie- Gogins (CEO) |
| Authorized Official Contact | 7739166513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mizani Therapeutic Services, Llc 2501 Chatham Rd # 5051 Springfield IL 62704-4188 Ph: (773) 916-6513 | Mizani Therapeutic Services, Llc 2501 Chatham Rd # 5051 Springfield IL 62704-4188 Ph: (773) 916-6513 |
| NPI Number | 1013749399 |
|---|---|
| Provider Enumeration Date | 08/15/2024 |
| Last Update Date | 09/04/2024 |
| Certification Date | 09/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013749399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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