Individual
ILSE MIRELLE ACEVEDO I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
451 N LASALLE, CHICAGO, IL 60654
(312) 893-7216
Mailing address
4211 W 55TH ST, CHICAGO, IL 60632-4625
(773) 905-2539
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149.021776
IL
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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