Individual
KELLY RICHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
581 WILLIAM LATHAM DR, BOURBONNAIS, IL 60914-2317
(815) 932-3823
Mailing address
16027 OAK AVE, OAK FOREST, IL 60452-4028
(815) 932-3823
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150,101968
IL
Other
Enumeration date
09/30/2016
Last updated
05/29/2020
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