Healthcare Provider Details

I. General information

NPI: 1053198614
Provider Name (Legal Business Name): PLDC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 W VAN BUREN ST
CHICAGO IL
60624-3050
US

IV. Provider business mailing address

4518 W VAN BUREN ST
CHICAGO IL
60624-3050
US

V. Phone/Fax

Practice location:
  • Phone: 773-750-5916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALYSSIA BELK
Title or Position: OWNER/DEVELOPMENTAL THERAPIST
Credential:
Phone: 773-750-5916