Individual
DEBRA CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16107 LA SALLE ST, SOUTH HOLLAND, IL 60473-2064
(800) 361-6880
(708) 845-5505
Mailing address
15127 S 73RD AVE STE G, ORLAND PARK, IL 60462-3425
(800) 361-6880
(708) 845-5505
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150102144
IL
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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