Organization
GLASTONBURY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY GILLETTE LCPC (OWNER)
(815) 290-9746
Entity
Organization
Contact information
Practice address
123 W WASHINGTON ST STE 325, OSWEGO, IL 60543-8254
(815) 290-9746
Mailing address
123 W WASHINGTON ST STE 325, OSWEGO, IL 60543-8254
(815) 290-9746
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
07/18/2022
Last updated
08/17/2022
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