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General NPI Number Information
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NPI Number | 1689331175
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Entity Type | Individual
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Provider Name | MADALYN RIVERA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 1642 E BARBERRY LN
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City | MT PROSPECT
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State | IL
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Zip | 60056-1512
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Country | US
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Telephone | 773-691-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 6158 W HENDERSON ST
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City | CHICAGO
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State | IL
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Zip | 60634-4180
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Country | US
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Telephone |
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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 |
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License Number State |
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