Individual
FREDERICK CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
1919 MAIN ST, HOPE HALL, MELROSE PARK, IL 60160-6016
(312) 810-4340
Mailing address
1919 MAIN STREET, HOPE HALL, MELROSE PARK, IL 60160-3737
(312) 810-4340
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
IL
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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