Provider Demographics
| NPI: | 1942346325 |
|---|---|
| Name: | INTERNATIONAL CONSULTING GROUP, INC. |
| Entity Type: | Organization |
| Organization Name: | INTERNATIONAL CONSULTING GROUP, INC. |
| Other - Org Name: | ICG REHAB SERVICES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | IWONA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KORZENIOWSKA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT |
| Authorized Official - Phone: | 312-943-3600 |
| Mailing Address - Street 1: | 1467 N ELSTON AVE STE 103 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHICAGO |
| Mailing Address - State: | IL |
| Mailing Address - Zip Code: | 60642-2449 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 312-943-3600 |
| Mailing Address - Fax: | 312-943-3096 |
| Practice Address - Street 1: | 1467 N ELSTON AVE STE 103 |
| Practice Address - Street 2: | |
| Practice Address - City: | CHICAGO |
| Practice Address - State: | IL |
| Practice Address - Zip Code: | 60642-2449 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 312-943-3600 |
| Practice Address - Fax: | 312-943-3096 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-30 |
| Last Update Date: | 2024-04-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YP2500X, 1041C0700X, 208000000X, 2080P0006X, 222Q00000X, 224Z00000X, 225100000X, 225200000X, 225X00000X, 2355S0801X | ||
| IL | 1010149 | 171R00000X, 235Z00000X, 251E00000X, 252Y00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 171R00000X | Other Service Providers | Interpreter | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 251E00000X | Agencies | Home Health |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IL | 103034 | Medicaid | |
| IL | 1630116 | Other | BCBS |
| IL | 103034 | Medicaid | |
| IL | 103034 | Medicaid |
