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Individual

EMMA NICOLE SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
2001 ALFORD PARK DR, KENOSHA, WI 53140-1994
(224) 330-8871
Mailing address
401 CHECKER DR, BUFFALO GROVE, IL 60089-1643
(224) 308-8871

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000051930
IL

Other

Enumeration date
03/01/2020
Last updated
06/23/2022
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