Individual
MS. DEBRA G. SIDDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DEVELOPMENTAL THERAP
Contact information
Practice address
4129 177TH ST, COUNTRY CLUB HILLS, IL 60478-4859
(708) 289-8730
Mailing address
4129 177TH ST, COUNTRY CLUB HILLS, IL 60478-4859
(708) 289-8730
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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