Organization
EMBOLDEN CLINICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS RANDALL BOWLING H.D. (PRESIDENT)
(630) 510-3248
Entity
Organization
Contact information
Practice address
1755 S NAPERVILLE RD, SUITE 100, WHEATON, IL 60187-8144
(630) 510-3248
Mailing address
1755 S NAPERVILLE RD, SUITE 100, WHEATON, IL 60187-8144
(630) 510-3248
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02220198
BLUE CROSS BLUE SHIELD
—
01
—
1043857
CIGNA
—
01
—
144300
COMPSYCHE
—
01
—
206272
MANAGED HEALTH NETWORK
—
01
—
5777746
AETNA
—
Enumeration date
08/01/2007
Last updated
08/01/2007
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