Individual
MRS. THERESA LYNN FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.T.
Contact information
Practice address
6301 SOUTH UNITY ROAD, POLO, IL 61064-9304
(815) 946-3402
(815) 946-3402
Mailing address
6301 S UNITY RD, POLO, IL 61064-9304
(815) 946-3402
(815) 946-3402
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178002457
IL
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
03/26/2007
Last updated
12/03/2019
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