Individual
MARIA LAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
3146 MAPLE AVE, BERWYN, IL 60402-2851
(708) 308-8351
(708) 484-8409
Mailing address
3146 MAPLE AVE, BERWYN, IL 60402-2851
(708) 484-8361
(708) 484-8409
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
ML31740803P
IL
Other
Enumeration date
05/05/2007
Last updated
07/23/2007
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