Provider Demographics
NPI:1063685527
Name:AFFILIATED CLINICIANS, S.C.
Entity type:Organization
Organization Name:AFFILIATED CLINICIANS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGADIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:847-438-2014
Mailing Address - Street 1:1217 MCHENRY RD
Mailing Address - Street 2:SUITE 238
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1379
Mailing Address - Country:US
Mailing Address - Phone:847-438-2014
Mailing Address - Fax:847-438-2690
Practice Address - Street 1:1217 MCHENRY RD
Practice Address - Street 2:SUITE 238
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1379
Practice Address - Country:US
Practice Address - Phone:847-438-2014
Practice Address - Fax:847-438-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL941900OtherMEDICARE