Individual
DEBARA DIANE SHADY-DAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DEVELOPMENTAL THERAP
Contact information
Practice address
109 LINDEN DR, COLONA, IL 61241-8807
(309) 738-8969
(309) 949-2135
Mailing address
109 LINDEN DR, COLONA, IL 61241-8807
(309) 738-8969
(309) 949-2135
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
DS71511099P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222Q00000X
DEVELOPMENTAL THERAPIST
IL
Enumeration date
03/31/2007
Last updated
07/08/2007
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