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General NPI Number Information
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NPI Number | 1225291529
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Entity Type | Individual
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Provider Name | JULITA COBBS NELOMS
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Gender | Female
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 3346 S PRAIRIE AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3920
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Country | US
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Telephone | 312-791-0028
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Fax |
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Provider Business Mailing Address
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Address Line | 3346 S PRAIRIE AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3920
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Country | US
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Telephone | 312-791-0028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | JN20260198P
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License Number State | IL
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