Individual
MS. LETITIA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
1030 W 18TH ST, BROADVIEW, IL 60155-5820
(708) 450-9383
Mailing address
1030 W 18TH ST, BROADVIEW, IL 60155-5820
(708) 450-9383
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
LD66460301P
IL
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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