Individual
MICKALA TAYLOR RANDBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8707 SKOKIE BLVD STE 310, SKOKIE, IL 60077-2281
(847) 568-1100
Mailing address
1528 N TALMAN AVE APT 2, CHICAGO, IL 60622-2376
(224) 567-9347
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.106595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150.106595
LSW
IL
Enumeration date
03/06/2023
Last updated
03/06/2023
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