Susan R. Davis Therapies, Inc. | |
3804 11th St Winthrop Harbor IL 60096-1461 | |
(847) 502-1007 | |
(815) 301-9025 |
Full Name | Susan R. Davis Therapies, Inc. |
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Speciality | Early Intervention Provider Agency |
Location | 3804 11th St, Winthrop Harbor, Illinois |
Authorized Official Name and Position | Susan R. Davis (PRESIDENT) |
Authorized Official Contact | 8475021007 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Susan R. Davis Therapies, Inc. 3804 11th St Winthrop Harbor IL 60096-1461 Ph: (847) 502-1007 | Susan R. Davis Therapies, Inc. 3804 11th St Winthrop Harbor IL 60096-1461 Ph: (847) 502-1007 |
NPI Number | 1104171917 |
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Provider Enumeration Date | 07/17/2012 |
Last Update Date | 07/17/2012 |
Identifier | Type | State | Issuer |
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1104171917 | NPI | - | NPPES |
180.007623 | Other | IL | ILLINOIS DEPT OF PROFESSIONAL AND FINANCIAL LICENSES |
SS12630298P | Other | IL | ILLINOIS EARLY INTERVENTION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 180.007623 (Illinois) | Secondary |
252Y00000X | Early Intervention Provider Agency | 180.007623 (Illinois) | Primary |