Organization
EVERGREEN PEDIATRIC GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA LEIGH DIXON MA, BCBA, LPC (BEHAVIOR ANALYST)
(815) 985-3882
Entity
Organization
Contact information
Practice address
157 REDMOND DR, GILBERTS, IL 60136-8026
(815) 985-3882
Mailing address
157 REDMOND DR, GILBERTS, IL 60136-8026
(815) 985-3882
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1-11-9409
IL
Other
Enumeration date
12/01/2011
Last updated
10/02/2013
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