Individual
JALISSA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6415 STANLEY AVE, BERWYN, IL 60402-3130
(708) 369-6920
Mailing address
6415 STANLEY AVE, BERWYN, IL 60402-3130
(708) 369-6920
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
IL
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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