Individual
ANDERSON PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1616 E ROOSEVELT RD STE 8, WHEATON, IL 60187-6850
(630) 588-8042
Mailing address
129 W FRONT ST, WHEATON, IL 60187-5108
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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