Individual
EDMUNDO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(847) 546-6450
Mailing address
31979 N FISH LAKE RD, ROUND LAKE, IL 60073-9517
(847) 546-6450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18030
IL
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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