Organization
FAMILY BUILDING BLOCKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY BOUCK MA (LCPC)
(773) 429-9454
Entity
Organization
Contact information
Practice address
10450 S WESTERN AVE, CHICAGO, IL 60643-2508
(773) 429-9454
Mailing address
10450 S WESTERN AVE, CHICAGO, IL 60643-2508
(773) 429-9454
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1825273
IL
Other
Enumeration date
08/21/2014
Last updated
08/21/2014
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