Individual
JULY MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2309 W 19TH ST, CHICAGO, IL 60608-2512
(312) 593-6597
Mailing address
2309 W 19TH ST, CHICAGO, IL 60608-2512
(312) 593-6597
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
222Q00000X
Developmental Therapist
—
IL
Other
Enumeration date
06/26/2018
Last updated
06/19/2020
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