Individual
MARTHA JEAN FRIDGE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBS1, ELEMENTAR ,ESL
Contact information
Practice address
642 E 49TH ST APT 2, CHICAGO, IL 60615-1554
(312) 834-4809
Mailing address
642 E 49TH ST APT 2, CHICAGO, IL 60615-1554
(312) 834-4809
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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