Meredith Bolan Therapy, LLC
Social Worker, Clinical in La Grange, IL. Organization (NPI-2).
NPI number1114596277
StatusActive
Last updated in NPPESJun 23, 2021
Details
- NPI
- 1114596277
- Entity type
- Organization (NPI-2)
- Legal business name
- Meredith Bolan Therapy, LLC
- Organization subpart
- No
- Enumeration date
- Jun 23, 2021
- Certification date
- Jun 23, 2021
- Last updated
- Jun 23, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
82 S La Grange Rd Ste 210La Grange, IL 60525-6348
Phone 630-446-0407
Mailing address
920 N Spring AveLa Grange Park, IL 60526-1477
Phone 708-528-5374
Authorized official
Meredith Bolan
Owner
7085285374
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