Individual
LAN LA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
343 W 30TH PL, CHICAGO, IL 60616-2652
(312) 823-4419
Mailing address
343 W 30TH PL, CHICAGO, IL 60616-2652
(312) 823-4419
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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