Individual
MRS. BERNICE SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.T.
Contact information
Practice address
450 PRAIRIE AVE, SUITE 103, CALUMET CITY, IL 60409-2125
(773) 339-1867
(708) 868-1290
Mailing address
303 STONEY ISLAND AVE, P.O. BOX 2510, CALUMET CITY, IL 60409-1726
(773) 339-1867
(708) 868-1290
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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