PAUL J. DETAEGE, LCSW, P.C.
Agencies at Ravenswood Ave, Chicago, IL

License number
Illinois 149008180
Category
Agencies
Type
Community/Behavioral Health
Owner
Name: MR. PAUL J DETAEGE LCSW
Title: PRESIDENT
Phone: (773) 988-4965
Address
Address
5215 N Ravenswood Ave SUITE 314, Chicago, IL 60640
National Provider ID: 1861780025
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PAUL J. DETAEGE, LCSW, PC

Chicago, IL 60626

Registration:
Jan 29, 2008
State ID:
65891085
Business type:
DOMESTIC BCA
Expiration:
PERPETUAL
Agent:
James L. Moles,6508 W Archer Ave, Chicago, IL 60638 (Physical)

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