Individual
JEFFERY SIDDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 JORIE BLVD, OAK BROOK, IL 60523-2215
(630) 710-5729
Mailing address
428 WESLEY AVE APT 2N, OAK PARK, IL 60302-3977
(708) 655-0864
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/09/2019
Last updated
07/23/2020
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