Provider Demographics
NPI:1891532750
Name:ASPEN ROOTS THERAPEUTIC SERVICES AND CONSULTING PLLC
Entity type:Organization
Organization Name:ASPEN ROOTS THERAPEUTIC SERVICES AND CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PERRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:779-206-8540
Mailing Address - Street 1:513 SEAN DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9765
Mailing Address - Country:US
Mailing Address - Phone:779-206-8540
Mailing Address - Fax:
Practice Address - Street 1:15105 S JAMES ST STE 7
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2171
Practice Address - Country:US
Practice Address - Phone:779-206-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty