Provider Demographics
NPI:1134568249
Name:ILLINOIS VALLEY COUNSELING SERVICES
Entity type:Organization
Organization Name:ILLINOIS VALLEY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-993-1614
Mailing Address - Street 1:1220 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9144
Mailing Address - Country:US
Mailing Address - Phone:815-993-1614
Mailing Address - Fax:
Practice Address - Street 1:807 LASALLE ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9144
Practice Address - Country:US
Practice Address - Phone:815-993-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490132691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty