Organization
CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERIC KIMLER (EXECUTIVE DIRECTOR)
(309) 431-5880
Entity
Organization
Contact information
Practice address
2112 E WAR MEMORIAL DR, PEORIA, IL 61614-8002
(309) 431-5880
Mailing address
2112 E WAR MEMORIAL DR, PEORIA, IL 61614-8002
(309) 431-5880
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
261QC1500X
Community Health Clinic/Center
—
—
363LC1500X
Community Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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