Provider Demographics
NPI:1699192799
Name:SKILL SPROUT
Entity Type:Organization
Organization Name:SKILL SPROUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KLEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-372-9684
Mailing Address - Street 1:524 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-9660
Mailing Address - Country:US
Mailing Address - Phone:708-372-9684
Mailing Address - Fax:
Practice Address - Street 1:97 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9271
Practice Address - Country:US
Practice Address - Phone:708-372-9684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006427385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child