Organization
THE ANTIOCH GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY WILSON (CREDENTIALING/BILLING SPECIALIST)
(309) 692-6622
Entity
Organization
Contact information
Practice address
6615 N. BIG HOLLOW RD., PEORIA, IL 61615-2451
(309) 692-6622
Mailing address
6615 N. BIG HOLLOW RD., PEORIA, IL 61615-2451
(309) 692-6622
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071-004483
IL
Other
Enumeration date
09/20/2006
Last updated
10/03/2024
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