Individual
MARY JANE MARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2014 W 102ND ST, CHICAGO, IL 60643-2027
(773) 636-3418
Mailing address
2014 W 102ND ST, CHICAGO, IL 60643-2027
(773) 636-3418
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
056001061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061649364
BCBS
IL
01
—
0071647296
BCBS
IL
Enumeration date
02/06/2007
Last updated
06/01/2015
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