Provider Demographics
NPI:1316438831
Name:COMMUNITY SERVICE COUNCIL OF NORTHERN WILL COUNTY
Entity type:Organization
Organization Name:COMMUNITY SERVICE COUNCIL OF NORTHERN WILL COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALNICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-886-5000
Mailing Address - Street 1:440 QUADRANGLE DR STE C
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3455
Mailing Address - Country:US
Mailing Address - Phone:815-886-5000
Mailing Address - Fax:
Practice Address - Street 1:440 QUADRANGLE DR STE C
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3455
Practice Address - Country:US
Practice Address - Phone:815-886-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty