Individual
COLLEEN T WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11235 S MAPLEWOOD AVE, CHICAGO, IL 60655-1420
(773) 343-3780
Mailing address
11235 S MAPLEWOOD AVE, CHICAGO, IL 60655-1420
(773) 343-3780
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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