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General NPI Number Information
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NPI Number | 1730643065
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 612 S CAMBRIDGE AVE
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City | ELMHURST
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State | IL
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Zip | 60126-4045
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Country | US
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Telephone | 630-209-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 612 S CAMBRIDGE AVE
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City | ELMHURST
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State | IL
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Zip | 60126-4045
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Country | US
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Telephone | 630-209-1650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA CARYN O'HALLORAN
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Credential |
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Telephone | 630-209-1650
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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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