JERRY THOMAS SOUTA JR

MELROSE PARK, IL
NPI1831259829
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: IL  149.010613)
Enumeration Date2006-12-11
Last Update Date2007-07-08
Business Address
Mr. JERRY THOMAS SOUTA JR LCSW
1414 MAIN ST
MELROSE PARK, IL 60160-3902
Phone number: 708-681-0073
Mailing Address
Mr. JERRY THOMAS SOUTA JR LCSW
21459 W BASSWOOD LN
PLAINFIELD, IL 60544-6367
Phone number: 815-483-5188
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