Basic Information
| Provider Information | |||||||||
| NPI: | 1992267645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF KENDALL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 W JOHN ST | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605609249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305539506 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 W JOHN ST | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605609249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305539506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | TOKARS | ||||||||
| AuthorizedOfficialFirstName: | AMAAL | ||||||||
| AuthorizedOfficialMiddleName: | V E | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6305539100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | ED.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | N | Agencies | Public Health or Welfare | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.