Individual
MISS OLGA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
3726 W AGATITE AVE, CHICAGO, IL 60625-5908
(773) 583-8856
Mailing address
3726 W AGATITE AVE, CHICAGO, IL 60625-5908
(773) 583-8856
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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