Individual
JACLYN ROSE MARZULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 681-0073
Mailing address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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