Individual
IVORY WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3220 ADAMS ST, BELLWOOD, IL 60104-2232
(708) 544-5677
Mailing address
3220 ADAMS ST, BELLWOOD, IL 60104-2232
(708) 544-5677
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
D14138856
IL
Other
Enumeration date
09/30/2018
Last updated
09/30/2018
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