First Name
Last Name
Email Address
Phone Number
Address (Optional)
State (Optional)
Zip (Optional)
Reason for Care
Insurance Name (Optional) Insurance ID # (Optional)
Insurance Group (Optional)
Best way to contact you? PhoneEmail
Service Location TelehealthIn Home Service
Service Type ---Skilled NursingDevelopmental TherapyOccupational TherapyPhysical TherapySpeech TherapyMental Health & Social ServicesDurable Medical EquipmentBrain Injury Case Management
Toll-free #: (866) 410-9210 Phone: (312) 943-3600 Fax: (312) 943-3096
Email: info@icgrehab.com
International Consulting Group, Inc. 1467 N Elston Avenue, Suite 103 Chicago, IL 60642-2449