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General NPI Number Information
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NPI Number | 1902552383
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Entity Type | Individual
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Provider Name | TRAVON CALVIN
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Gender | Male
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 4549 S LAPORTE AVE
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City | CHICAGO
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State | IL
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Zip | 60638-1949
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Country | US
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Telephone | 773-585-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 204 WILDWOOD LN
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City | JOLIET
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State | IL
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Zip | 60433-2945
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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