Individual
LAURA COSTELLO SANTIAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, M.ED, M.J
Contact information
Practice address
6126 N LEADER AVE, CHICAGO, IL 60646-4806
(312) 771-7151
Mailing address
6126 N LEADER AVE, CHICAGO, IL 60646-4806
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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