Provider Demographics
NPI:1417221268
Name:LLAKE COUNTY
Entity Type:Organization
Organization Name:LLAKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONS COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:TREZEK
Authorized Official - Suffix:
Authorized Official - Credentials:BS/CADC
Authorized Official - Phone:630-639-9507
Mailing Address - Street 1:725 MANDRAKE DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3203
Mailing Address - Country:US
Mailing Address - Phone:630-639-9507
Mailing Address - Fax:
Practice Address - Street 1:725 MANDRAKE DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3203
Practice Address - Country:US
Practice Address - Phone:630-639-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health