Provider Demographics
NPI:1992708960
Name:EASTER SEALS JOLIET REGION INC.
Entity type:Organization
Organization Name:EASTER SEALS JOLIET REGION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MA CRC
Authorized Official - Phone:815-725-2194
Mailing Address - Street 1:212 BARNEY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5271
Mailing Address - Country:US
Mailing Address - Phone:815-725-2194
Mailing Address - Fax:815-725-5150
Practice Address - Street 1:212 BARNEY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5271
Practice Address - Country:US
Practice Address - Phone:815-725-2194
Practice Address - Fax:815-725-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCO01038599261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities