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Organization
MEREDITH BOLAN THERAPY, LLC
Active
Organization
MEREDITH BOLAN THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH BOLAN (OWNER)
(708) 528-5374
Entity
Organization
Contact information
Practice address
82 S LA GRANGE RD STE 210, LA GRANGE, IL 60525-6348
(630) 446-0407
Mailing address
920 N SPRING AVE, LA GRANGE PARK, IL 60526-1477
(708) 528-5374
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149021859
LICENSE NUMBER
IL
Enumeration date
06/23/2021
Last updated
06/23/2021
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