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201 W Springfield Ave Ste 1201 Champaign IL 61820-6385 | |
| (217) 722-9079 | |
| (217) 501-4322 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 201 W Springfield Ave Ste 1201, Champaign, Illinois |
| Authorized Official Name and Position | Robert J Mcnicholl (PRESIDENT-CEO) |
| Authorized Official Contact | 2177229079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
201 W Springfield Ave Ste 1201 Champaign IL 61820-6385 Ph: (217) 722-9079 | 201 W Springfield Ave Ste 1201 Champaign IL 61820-6385 Ph: (217) 722-9079 |
| NPI Number | 1669774535 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669774535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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