Individual
MR. AUGUST SUPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
750 BROADWAY AVE E, MATTOON, IL 61938-4610
(217) 238-5700
(217) 238-5767
Mailing address
750 BROADWAY AVE E, MATTOON, IL 61938-4610
(217) 238-5700
(217) 238-5767
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-007817
IL
Other
Enumeration date
10/04/2006
Last updated
08/04/2015
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