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1881817443
KELLY R. BRODERICK
LA GRANGE, IL
NPI
1881817443
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
222Q00000X Developmental Therapist
Enumeration Date
2007-04-11
Last Update Date
2007-07-08
Business Address
MRS. KELLY R. BRODERICK L.P.C.
515 S ASHLAND AVE
LA GRANGE, IL 60525-2812
Phone number: 708-352-1880
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Mailing Address
MRS. KELLY R. BRODERICK L.P.C.
515 S ASHLAND AVE
LA GRANGE, IL 60525-2812
Phone number: 708-352-1880
Copy
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