Individual
MRS. IVY AMELIA DOMONT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
85 REVERE DR STE AA, NORTHBROOK, IL 60062-8001
(847) 564-0822
Mailing address
85 REVERE DR STE AA, NORTHBROOK, IL 60062-8001
(847) 564-0822
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-17998
PA
Other
Enumeration date
02/12/2016
Last updated
02/12/2016
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