Individual
MAYRA YADIRA ISIDORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
58 E CLINTON ST, JOLIET, IL 60432-4143
(815) 723-0331
Mailing address
177 S VILLA AVE, ELMHURST, IL 60126-3030
(630) 843-2149
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
04/22/2020
Last updated
04/22/2020
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