Individual
MARLENA LYNN SJOSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
459 PINE WHITE RD UNIT 4, ROSCOE, IL 61073-5667
(815) 979-6874
Mailing address
459 PINE WHITE RD UNIT 4, ROSCOE, IL 61073-5667
(815) 979-6874
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/24/2013
Last updated
06/24/2013
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