Individual
KELLEY MANGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
137 W 111TH ST, CHICAGO, IL 60628-4214
(773) 614-4002
(773) 453-3262
Mailing address
137 W 111TH ST, CHICAGO, IL 60628-4214
(773) 614-4002
(773) 453-3262
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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