MEDICARE: LYMARIS GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER	IL	DEVELOPMENTAL THERAPY

General Provider Information

NPI Number	:	1538687421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYMARIS GONZALEZ

Provider Business Mailing Address
First Line	:	1938 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-822-2913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1938 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3607
Country	:	US
Telephone Number	:	773-822-2913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	07/21/2022

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