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Organization

PROVIDER CONNECTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DONNA MARIE MITCHEM (DEVELOPMENTAL THERAPIST)
(773) 853-9832
Entity
Organization

Contact information

Practice address
1036 N. HAMLIN AVE, CHICAGO, IL 60651-3830
(773) 853-9832
Mailing address
1036 N HAMLIN AVE, CHICAGO, IL 60651-3830
(773) 853-9832

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary

Other

Enumeration date
01/23/2012
Last updated
01/23/2012
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