Individual
BRANDY SIMONE HENLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 FORESTDALE PARK, CALUMET CITY, IL 60409-5309
(328) 567-7817
Mailing address
755 E 104TH ST, CHICAGO, IL 60628-3018
(312) 856-7817
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/03/2019
Last updated
03/03/2019
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