Provider Demographics
NPI:1407081474
Name:GROWING EDGE INC
Entity Type:Organization
Organization Name:GROWING EDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-493-8045
Mailing Address - Street 1:PO BOX 2713
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61825-2713
Mailing Address - Country:US
Mailing Address - Phone:217-493-8045
Mailing Address - Fax:217-244-8961
Practice Address - Street 1:1401 REGENCY DR E
Practice Address - Street 2:SUITE #2
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9312
Practice Address - Country:US
Practice Address - Phone:217-493-8045
Practice Address - Fax:217-244-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0028961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty