Healthcare Provider Details

I. General information

NPI: 1659742930
Provider Name (Legal Business Name): DBA DEVELOPING MELODIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E LINCOLN ST STE 209
NORMAL IL
61761-6406
US

IV. Provider business mailing address

705 E LINCOLN ST STE 209
NORMAL IL
61761-6406
US

V. Phone/Fax

Practice location:
  • Phone: 309-212-6204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MERY BROWN
Title or Position: OWNER, MUSIC THERAPIST
Credential: MM, MT-BC, DT
Phone: 309-212-6204