Organization
DOCHAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE MARTIN (OWNER)
(815) 603-8632
Entity
Organization
Contact information
Practice address
16W361 S FRONTAGE RD, STE 131, BURR RIDGE, IL 60527-5830
(630) 590-5571
Mailing address
3611 INDIAN HEAD LN, JOLIET, IL 60435-1590
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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