Individual
THERESA TALIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 BAKER RD, LAKE BLUFF, IL 60044-1424
(630) 486-7068
Mailing address
122 BAKER RD, LAKE BLUFF, IL 60044-1424
(630) 486-7068
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
060991056
IL
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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