Individual
SOREIDA MAMIE FENNERR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7729 S LOOMIS BLVD, CHICAGO, IL 60620-3751
(773) 787-9278
Mailing address
7729 S LOOMIS BLVD, CHICAGO, IL 60620-3751
(773) 787-9278
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
IL
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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