| Windy City Therapeutic Llc | |
|
2201 Lakeside Dr Bannockburn IL 60015-1265 | |
| (773) 319-6265 | |
| Not Available |
| Full Name | Windy City Therapeutic Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2201 Lakeside Dr, Bannockburn, Illinois |
| Authorized Official Name and Position | Angela M. Fadragas (OWNER) |
| Authorized Official Contact | 3125471931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Windy City Therapeutic Llc 2201 Lakeside Dr Ste 601 Bannockburn IL 60015-1265 Ph: (312) 547-1931 | Windy City Therapeutic Llc 2201 Lakeside Dr Bannockburn IL 60015-1265 Ph: (773) 319-6265 |
| NPI Number | 1740697697 |
|---|---|
| Provider Enumeration Date | 07/11/2014 |
| Last Update Date | 04/05/2023 |
| Certification Date | 04/05/2023 |
| Medicare PECOS PAC ID | 3779992730 |
|---|---|
| Medicare Enrollment ID | O20210504002993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740697697 | NPI | - | NPPES |
| Provider Name | Angela M Fadragas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063460350 PECOS PAC ID: 4486975646 Enrollment ID: I20150601000894 |
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