Organization Name: | ILLINOIS VALLEY COUNSELING SERVICES |
NPI Number: | 1134568249 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHAWN W SLAGLE (OWNER) |
Mailing Address: | 807 Lasalle St Ottawa |
State: | IL US |
Postal Code: | 613509144 |
Phone Number: | 8159931614 |
Fax Number: | |
NPI Enumeration Date: | 06/21/2013 |
NPI Last Update Date: | 06/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149013269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |