| The Antioch Group, Inc. | |
|
6615 N. Big Hollow Rd. Peoria IL 61615-2451 | |
| (309) 692-6622 | |
| Not Available |
| Full Name | The Antioch Group, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 6615 N. Big Hollow Rd., Peoria, Illinois |
| Authorized Official Name and Position | Shelley Wilson (CREDENTIALING/BILLING SPECIALIST) |
| Authorized Official Contact | 3096926622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Antioch Group, Inc. 6615 N. Big Hollow Rd. Peoria IL 61615-2451 Ph: (309) 692-6622 | The Antioch Group, Inc. 6615 N. Big Hollow Rd. Peoria IL 61615-2451 Ph: (309) 692-6622 |
| NPI Number | 1801993142 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Medicare PECOS PAC ID | 8224920764 |
|---|---|
| Medicare Enrollment ID | O20040329000526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801993142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 071-004483 (Illinois) | Primary |
| Provider Name | Patricia J Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356444913 PECOS PAC ID: 5092607580 Enrollment ID: I20040329000832 |
| Provider Name | Maggie Classen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194973404 PECOS PAC ID: 0345300083 Enrollment ID: I20081125000422 |
| Provider Name | Steven Allen Hamon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174626782 PECOS PAC ID: 5092607549 Enrollment ID: I20101106000028 |
| Provider Name | Barbara Toohill |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205127784 PECOS PAC ID: 6305024639 Enrollment ID: I20110708000548 |
| Provider Name | Heidi A Grafton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932793049 PECOS PAC ID: 3274942859 Enrollment ID: I20210512000054 |
| Provider Name | Kevin Siscoe |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043632524 PECOS PAC ID: 6204287279 Enrollment ID: I20240104001251 |
| Provider Name | David Bruce Bucknam |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760516207 PECOS PAC ID: 7315398260 Enrollment ID: I20240104004401 |
| Provider Name | Patricia A Poertner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356444970 PECOS PAC ID: 6901259399 Enrollment ID: I20240201002891 |
| Provider Name | Jason Woodford |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740669761 PECOS PAC ID: 1254870462 Enrollment ID: I20240830002020 |
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