Organization
NORTHWEST AUTISM DIAGNOSTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY DIRKSEN PHD (OWNER)
(224) 206-5415
Entity
Organization
Contact information
Practice address
394 FEDERAL DR, CRYSTAL LAKE, IL 60014-6281
(224) 206-5415
Mailing address
PO BOX 2257, CHESTERTON, IN 46304-0357
(219) 926-8320
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/25/2020
Last updated
09/25/2020
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