Provider Demographics
NPI: | 1780139253 |
---|---|
Name: | INTEGRATED THERAPY SERVICES |
Entity type: | Organization |
Organization Name: | INTEGRATED THERAPY SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WEILER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 618-783-7529 |
Mailing Address - Street 1: | 102 N JACKSON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWTON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62448-1900 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 618-783-7529 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 102 N JACKSON ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWTON |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62448-1900 |
Practice Address - Country: | US |
Practice Address - Phone: | 618-783-7529 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-24 |
Last Update Date: | 2016-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 103K00000X, 224Z00000X, 373H00000X | ||
IL | 149015563 | 1041C0700X |
IL | 222Q00000X | |
IL | 160005508 | 225200000X |
IL | 056008112 | 225X00000X |
IL | 146012895 | 235Z00000X |
IL | 242003718 | 235Z00000X |
IL | 146008181 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | 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 | 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 | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Multi-Specialty |