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Individual

ANN BACON DAVIDSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
600 N BRADLEY RD, LAKE FOREST, IL 60045-1020
(847) 615-8696
Mailing address
872 S MILWAUKEE AVE # 273, LIBERTYVILLE, IL 60048-3227

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
056.001865
IL

Other

Enumeration date
06/24/2009
Last updated
06/24/2009
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