Individual
MRS. AMY J GOMOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.T.
Contact information
Practice address
582 ARBOR LN, SOUTH ELGIN, IL 60177-2864
(847) 741-4675
Mailing address
582 ARBOR LN, SOUTH ELGIN, IL 60177-2864
(847) 741-4675
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
AG34481006P
IL
Other
Enumeration date
03/28/2007
Last updated
07/08/2007
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