Organization
PLAY DATE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE BRENNAN (PRESIDENT)
(708) 259-3171
Entity
Organization
Contact information
Practice address
5624 S MEADE AVE, CHICAGO, IL 60638-3504
(708) 259-3171
Mailing address
5624 S MEADE AVE, CHICAGO, IL 60638-3504
(708) 259-3171
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326464546
DEVELOPMENTAL THERAPIST
—
Enumeration date
10/02/2019
Last updated
10/02/2019
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