Individual
JACQUELINE CALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4904 W. 32ND ST, CICERO, IL 60804
(312) 342-2642
Mailing address
4904 W. 32ND ST, CICERO, IL 60804
(312) 342-2642
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
C42042292898
IL
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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