# OPEN DOOR CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174902555
- **Authorized official:** MR. DAVID ROESLER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (630) 707-7704

## Contact information

- **Practice address:** 157 S LINCOLN AVE, SUITE K, AURORA, IL 60505-4264
- **Practice address phone:** (630) 264-1819
- **Practice address fax:** (630) 229-0182
- **Mailing address:** 157 S LINCOLN AVE, SUITE K, AURORA, IL 60505-4264
- **Mailing address phone:** (630) 264-1819
- **Mailing address fax:** (630) 229-0182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | NULL | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/19/2015
- **Last updated:** 05/19/2015