Ben Gordon Center

NPI #1700037512 in Dekalb, Illinois

Provider Information

NPI Number: 1700037512
Entity Type: Organization
Organization Name: Ben Gordon Center
Subpart: Yes (part of a larger organization)
Parent Organization: BEN GORDON CENTER
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Oct 10, 2008
Last Updated: Oct 10, 2008

Practice Location

Address: 12 HEALTH SERVICES DR
City: Dekalb
State: Illinois
ZIP Code: 60115-9637
Phone: (815) 756-4875

Authorized Official

Name: MRS. KIMBERLY KRUPPENBACHER
Title: CREDENTIALING COORDINATOR
Phone: (815) 756-4875

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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