Individual
MRS. DEBRA ANN MICKSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.T.
Contact information
Practice address
14270 W WALDEN LN, WADSWORTH, IL 60083-9561
(847) 623-2975
Mailing address
14270 W WALDEN LN, WADSWORTH, IL 60083-9561
(847) 623-2975
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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