Individual
MARISSA NICOLE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7634 W BALMORAL AVE, CHICAGO, IL 60656-1724
(613) 804-4268
Mailing address
10 COUNTRY CT, LEMONT, IL 60439-4183
(630) 247-2494
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
12/22/2017
Last updated
12/22/2017
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