Individual
JENISE FREDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
2744 W 94TH ST, EVERGREEN PARK, IL 60805-2519
(773) 849-4500
Mailing address
2744 W 94TH ST, EVERGREEN PARK, IL 60805-2519
(773) 849-4500
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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