Individual
LORA GARDINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7626 W 25TH ST, NORTH RIVERSIDE, IL 60546-1416
(708) 853-9796
Mailing address
7626 W 25TH ST, NORTH RIVERSIDE, IL 60546-1416
(708) 853-9796
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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