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Organization
NICASA, NFP
Active
Organization
NICASA, NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SNELTEN (CHIEF OPERATING OFFICER)
(847) 546-6450
Entity
Organization
Contact information
Practice address
1113 W GREENWOOD AVE, WAUKEGAN, IL 60087-4908
(847) 244-4434
(847) 244-4098
Mailing address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(814) 546-6450
(847) 546-6760
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
14012
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14012
ILLINOIS DEPT OF HUMAN SERVICES
IL
Enumeration date
10/07/2016
Last updated
04/07/2021
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