Individual
MRS. KELLY JEAN WYDRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.P.C., C.A.D.C.
Contact information
Practice address
4923 MAIN ST, DOWNERS GROVE, IL 60515-3654
(815) 651-1983
Mailing address
1223 RHODES LN, NAPERVILLE, IL 60540-0341
(815) 651-1983
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.007933
IL
Other
Enumeration date
12/05/2016
Last updated
12/05/2016
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