Individual
MS. DOMANIQUE L LADD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
87 FIR ST, PARK FOREST, IL 60466-1706
(708) 830-5320
Mailing address
87 FIR ST, PARK FOREST, IL 60466-1706
(708) 830-5320
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
IL
174400000X
Specialist
—
IL
Other
Enumeration date
02/15/2017
Last updated
02/15/2017
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