Individual
MISS KRYSTAL LYNNETTE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7806 S WOOD ST, CHICAGO, IL 60620-4446
(773) 633-7466
Mailing address
7806 S WOOD ST, CHICAGO, IL 60620-4446
(773) 633-7466
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/06/2017
Last updated
07/06/2017
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