Individual
MIRIAM A MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28W671 GARYS MILL RD, WINFIELD, IL 60190-1564
(630) 293-9860
(630) 293-9861
Mailing address
28W671 GARYS MILL RD, WINFIELD, IL 60190-1564
(630) 293-9860
(630) 293-9861
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/23/2017
Last updated
07/12/2021
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