Provider Demographics
NPI:1629856448
Name:PERSONAL PATH
Entity Type:Organization
Organization Name:PERSONAL PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-632-0940
Mailing Address - Street 1:1333 BURR RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0833
Mailing Address - Country:US
Mailing Address - Phone:708-400-9146
Mailing Address - Fax:
Practice Address - Street 1:1333 BURR RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0833
Practice Address - Country:US
Practice Address - Phone:708-400-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health