Organization
NORTHWESTERN LAKE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLENE LETA KRIEGER RNCADCCRSS (OWNER/DIRECTOR)
(847) 587-8400
Entity
Organization
Contact information
Practice address
17 WEST GRAND AVE., FOX LAKE, IL 60020
(847) 587-8400
(847) 587-8407
Mailing address
17 W GRAND AVE, FOX LAKE, IL 60020-1209
(847) 587-8400
(847) 587-8407
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
A-2237-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356679534
RNCADCCRSS
IL
01
—
1598075269
CADC
IL
01
—
1720398092
CADC
IL
Enumeration date
10/28/2010
Last updated
11/01/2010
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