Individual
ROSA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 GLENWOOD AVE STE 126, JOLIET, IL 60435-5495
(815) 730-7521
Mailing address
2400 GLENWOOD AVE STE 126, JOLIET, IL 60435-5495
(815) 730-7521
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
27208
IL
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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