Individual
MISS PAMELA TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7611 S CRANDON AVE, CHICAGO, IL 60649-4116
(773) 510-4909
Mailing address
7611 S CRANDON AVE, CHICAGO, IL 60649-4116
(773) 510-4909
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7611
NOT SURE
—
Enumeration date
03/04/2020
Last updated
03/04/2020
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