Individual
CITLALI MARIELI LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
555 N ASHBURY AVE, BOLINGBROOK, IL 60440-1269
(630) 770-7469
Mailing address
1440 W TAYLOR ST # 2059, CHICAGO, IL 60607-4623
(630) 770-7469
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
108592
IL
Other
Enumeration date
07/13/2023
Last updated
01/26/2024
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