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Organization

CRAWFORD AVENUE GROUP INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLI KLINGER (PRESIDENT)
(847) 875-4411
Entity
Organization

Contact information

Practice address
2530 CRAWFORD AVE STE 206, EVANSTON, IL 60201-4959
(847) 875-4411
Mailing address
2530 CRAWFORD AVE STE 206, EVANSTON, IL 60201-4959

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007124
IL
1041C0700X
Clinical Social Worker
149003065
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000603083
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
01
1619019080
TYPE 1-NPI
IL
01
1891819363
TYPE 1-NPI
IL
Enumeration date
06/02/2018
Last updated
06/02/2018
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