Individual
KIMBERLY VIRGO RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
2818 S TRIPP AVE, CHICAGO, IL 60623-4336
(773) 240-5377
(815) 377-2424
Mailing address
7208 W LUNT AVE, CHICAGO, IL 60631-1125
(708) 717-6594
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
06/13/2010
Last updated
06/30/2016
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