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Organization

GRUNDY EUNOIA WELLNESS CENTER NFP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER PARKER (BILLING ADMINISTRATOR)
(815) 513-3654
Entity
Organization

Contact information

Practice address
606 DEPOT ST, MAZON, IL 60444-3703
(815) 513-3654
Mailing address
PO BOX 74, MAZON, IL 60444-0074

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2084P0800X
Psychiatry Physician
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
07/09/2024
Last updated
06/18/2025
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