Organization
FOURCORNERS WELLNESS CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN M POLKY LCSW (FOUNDER/PRESIDENT)
(815) 988-4370
Entity
Organization
Contact information
Practice address
4001 N PERRYVILLE RD, LOVES PARK, IL 61111-8644
(815) 988-4370
Mailing address
4001 N PERRYVILLE RD, LOVES PARK, IL 61111-8644
(815) 988-4370
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/15/2024
Last updated
03/15/2024
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