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1113 S Milwaukee Ave Suite 104 Libertyville IL 60048-3758 | |
| (847) 367-5991 | |
| (847) 367-5997 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1113 S Milwaukee Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Gina Tober (DIRECTOR OF CLINICAL SERVICES) |
| Authorized Official Contact | 8477480385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1113 S Milwaukee Ave Suite 104 Libertyville IL 60048-3758 Ph: (847) 367-5991 | 1113 S Milwaukee Ave Suite 104 Libertyville IL 60048-3758 Ph: (847) 367-5991 |
| NPI Number | 1487770798 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 04/13/2020 |
| Certification Date | 04/13/2020 |
| Medicare PECOS PAC ID | 3173674678 |
|---|---|
| Medicare Enrollment ID | O20090623000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487770798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | James H Shackelford |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326077785 PECOS PAC ID: 5092895565 Enrollment ID: I20080109000670 |
| Provider Name | Carol M Saldinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619096997 PECOS PAC ID: 6305027962 Enrollment ID: I20110302000355 |
| Provider Name | Christine E Spuhler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962784868 PECOS PAC ID: 8628367992 Enrollment ID: I20160510002470 |
| Provider Name | Kathryn Nixon Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043792823 PECOS PAC ID: 4981059136 Enrollment ID: I20231009002646 |
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