| County Of Henry | |
|
110 N Burr Blvd Kewanee IL 61443-2214 | |
| (309) 852-0197 | |
| (309) 852-0595 |
| Full Name | County Of Henry |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 N Burr Blvd, Kewanee, Illinois |
| Authorized Official Name and Position | Tara Lafollette (CREDENTIALING REPRESENTATIVE) |
| Authorized Official Contact | 3098520197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Of Henry 110 N Burr Blvd Kewanee IL 61443-2214 Ph: (309) 852-0197 | County Of Henry 110 N Burr Blvd Kewanee IL 61443-2214 Ph: (309) 852-0197 |
| NPI Number | 1265066625 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 02/25/2020 |
| Medicare PECOS PAC ID | 5193828556 |
|---|---|
| Medicare Enrollment ID | O20190613000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265066625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Alexandra Kristine Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558137943 PECOS PAC ID: 1951844232 Enrollment ID: I20240614000906 |
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