Individual
MICHELLE D IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4119 W HARRISON ST, CHICAGO, IL 60624-3549
(708) 307-2191
Mailing address
4119 W HARRISON ST, CHICAGO, IL 60624-3549
(708) 307-2191
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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