Organization
DEVELOPMENTAL SPECIALISTS OF SOUTHEASTERN IL, INC.
Active
Organization
DEVELOPMENTAL SPECIALISTS OF SOUTHEASTERN IL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE ROSS (PRESIDENT)
(618) 393-7732
Entity
Organization
Contact information
Practice address
905 E MAIN ST, OLNEY, IL 62450-2623
(618) 393-7732
(618) 395-3123
Mailing address
905 E MAIN ST, OLNEY, IL 62450-2623
(618) 393-7732
(618) 395-3123
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8030288
BLUECROSS/BLUE SHIELD IL
IL
Enumeration date
08/20/2006
Last updated
04/09/2009
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