| Meredith Bolan Therapy, Llc | |
|
82 S La Grange Rd Ste 210 La Grange IL 60525-6348 | |
| (630) 446-0407 | |
| Not Available |
| Full Name | Meredith Bolan Therapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 82 S La Grange Rd Ste 210, La Grange, Illinois |
| Authorized Official Name and Position | Meredith Bolan (OWNER) |
| Authorized Official Contact | 7085285374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Meredith Bolan Therapy, Llc 920 N Spring Ave La Grange Park IL 60526-1477 Ph: (708) 528-5374 | Meredith Bolan Therapy, Llc 82 S La Grange Rd Ste 210 La Grange IL 60525-6348 Ph: (630) 446-0407 |
| NPI Number | 1114596277 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 06/23/2021 |
| Certification Date | 06/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114596277 | NPI | - | NPPES |
| 149021859 | Other | IL | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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