Individual
MRS. JAIME BOUDROS MOSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 S CHARLES AVE, VILLA PARK, IL 60181-2618
(630) 204-3366
Mailing address
32 S CHARLES AVE, VILLA PARK, IL 60181-2618
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
JB23770301P
IL
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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