Individual
MR. JOHN MYRON NETHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 715-8109
Mailing address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 715-8109
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
36-2709982
IL
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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