Individual
MRS. LAURA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 S CALUMET RD STE 3, CHESTERTON, IN 46304
(219) 983-9675
Mailing address
1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
(219) 983-9675
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/14/2009
Last updated
07/08/2019
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