| Provena St Marys Hospital | |
|
21 Heritage Drive Suite 102 Bourbonnais IL 60914 | |
| (815) 937-2081 | |
| (815) 937-8798 |
| Full Name | Provena St Marys Hospital |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 21 Heritage Drive, Bourbonnais, Illinois |
| Authorized Official Name and Position | Barry S Lee (EAP SUBSTANCE ABUSE COUNSELOR) |
| Authorized Official Contact | 8159372081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provena St Marys Hospital 21 Heritage Drive Suite 102 Bourbonnais IL 60914 Ph: (815) 937-2081 | Provena St Marys Hospital 21 Heritage Drive Suite 102 Bourbonnais IL 60914 Ph: (815) 937-2081 |
| NPI Number | 1194982025 |
|---|---|
| Provider Enumeration Date | 05/19/2008 |
| Last Update Date | 05/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194982025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149006455 (Illinois) | Primary |
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