| Self | |
|
9750 Crescent Park Cir Unit 306 Orland Park IL 60462 | |
| (773) 852-0904 | |
| Not Available |
| Full Name | Self |
|---|---|
| Speciality | Counselor |
| Location | 9750 Crescent Park Cir Unit 306, Orland Park, Illinois |
| Authorized Official Name and Position | Susan Ryan-michalak (COUNSELOR) |
| Authorized Official Contact | 7738520904 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self 14213 Woodward Dr Orland Park IL 60462-2372 Ph: () - | Self 9750 Crescent Park Cir Unit 306 Orland Park IL 60462 Ph: (773) 852-0904 |
| NPI Number | 1689168478 |
|---|---|
| Provider Enumeration Date | 06/15/2018 |
| Last Update Date | 08/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689168478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 180.009374 (Illinois) | Primary |
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