Provider Demographics
NPI:1659708352
Name:INSIGHT THERAPEUTICS
Entity Type:Organization
Organization Name:INSIGHT THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKLEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, NCC, LCPC
Authorized Official - Phone:847-752-9969
Mailing Address - Street 1:27W140 ROOSEVELT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1642
Mailing Address - Country:US
Mailing Address - Phone:847-752-9969
Mailing Address - Fax:847-628-0791
Practice Address - Street 1:27W140 ROOSEVELT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1642
Practice Address - Country:US
Practice Address - Phone:847-752-9969
Practice Address - Fax:847-628-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006950251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11876841OtherCAQH