Provider Demographics
NPI:1114237153
Name:NORTHERN ILLINOIS UNIVERSITY
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS UNIVERSITY
Other - Org Name:FAMILY CENTER OF NIU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT, DEAN/FINANCE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-753-6161
Mailing Address - Street 1:146 WIRTZ HALL
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3088
Mailing Address - Country:US
Mailing Address - Phone:815-753-1684
Mailing Address - Fax:815-753-1627
Practice Address - Street 1:146 WIRTZ HALL
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3088
Practice Address - Country:US
Practice Address - Phone:815-753-1684
Practice Address - Fax:815-753-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty