Individual
CHARDONNAY HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7627 LAKE STREET, SUITE 206 PMB 1005, RIVER FOREST, IL 60305-1878
(708) 316-9951
(708) 367-6934
Mailing address
7627 LAKE STREET, SUITE 206 PMB 1005, RIVER FOREST, IL 60305-1878
(708) 316-9951
(708) 367-6934
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
KAESVF8SO6
IL
Other
Enumeration date
06/11/2019
Last updated
06/15/2024
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