Individual
MS. DEANDREA DENISE FEDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TVI
Contact information
Practice address
11400 S ADA ST, CHICAGO, IL 60643-4428
(773) 954-4997
Mailing address
11400 S ADA ST, CHICAGO, IL 60643-4428
(773) 954-4997
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
04/25/2011
Last updated
04/25/2011
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