| Bridge Southwest Dupage, Mindstrong, Emerge | |
|
777 Oakmont Ln # 1600 Westmont IL 60559-5511 | |
| (773) 572-5500 | |
| Not Available |
| Full Name | Bridge Southwest Dupage, Mindstrong, Emerge |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 777 Oakmont Ln # 1600, Westmont, Illinois |
| Authorized Official Name and Position | Marcella Klauer (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 7735725480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Southwest Dupage, Mindstrong, Emerge 4101 N Ravenswood Ave Chicago IL 60613-2193 Ph: (773) 572-5500 | Bridge Southwest Dupage, Mindstrong, Emerge 777 Oakmont Ln # 1600 Westmont IL 60559-5511 Ph: (773) 572-5500 |
| NPI Number | 1679027734 |
|---|---|
| Provider Enumeration Date | 08/06/2016 |
| Last Update Date | 09/08/2021 |
| Certification Date | 09/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679027734 | NPI | - | NPPES |
| 04133 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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