Provider Demographics
NPI:1417492406
Name:STRADER VOCATIONAL AND REHABILITATION CONSULTING, INC
Entity type:Organization
Organization Name:STRADER VOCATIONAL AND REHABILITATION CONSULTING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-346-6641
Mailing Address - Street 1:106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3015
Mailing Address - Country:US
Mailing Address - Phone:618-346-6641
Mailing Address - Fax:618-346-6638
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3015
Practice Address - Country:US
Practice Address - Phone:618-346-6641
Practice Address - Fax:618-346-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty