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741 S Mchenry Ave Ste C Crystal Lake IL 60014-7445 | |
| (224) 623-2699 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 741 S Mchenry Ave Ste C, Crystal Lake, Illinois |
| Authorized Official Name and Position | Lisa Sloka (OWNER) |
| Authorized Official Contact | 2246232699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
741 S Mchenry Ave Ste C Crystal Lake IL 60014-7445 Ph: (224) 623-2699 | 741 S Mchenry Ave Ste C Crystal Lake IL 60014-7445 Ph: (224) 623-2699 |
| NPI Number | 1750114542 |
|---|---|
| Provider Enumeration Date | 08/26/2024 |
| Last Update Date | 10/11/2024 |
| Certification Date | 10/11/2024 |
| Medicare PECOS PAC ID | 6204360720 |
|---|---|
| Medicare Enrollment ID | O20241106002734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750114542 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Lisa Marie Sloka |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194458190 PECOS PAC ID: 9830538024 Enrollment ID: I20240422000241 |
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