Organization
SKILL SPROUT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE LYNNE KLEIST (THERAPIST)
(708) 372-9684
Entity
Organization
Contact information
Practice address
97 EASTGATE DR, WASHINGTON, IL 61571-9271
(708) 372-9684
Mailing address
524 CRESTVIEW DR, METAMORA, IL 61548-9660
(708) 372-9684
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
178006427
IL
Other
Enumeration date
03/26/2014
Last updated
03/26/2014
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