Individual
MARY CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2435 KENILWORTH AVE, BERWYN, IL 60402-2546
(708) 795-2364
Mailing address
5724 WOODLAND DR, WESTERN SPRINGS, IL 60558-2137
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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