Individual
RENEE IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7060 MADISON ST, MERRILLVILLE, IN 46410-3452
(219) 840-8209
Mailing address
7060 MADISON ST, MERRILLVILLE, IN 46410-3452
(219) 840-8209
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/11/2016
Last updated
01/14/2016
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