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1972001709
THIDAPORN IAMSUTTA
CHICAGO, IL
NPI
1972001709
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)
Enumeration Date
2018-01-26
Last Update Date
2018-01-26
Business Address
THIDAPORN IAMSUTTA QMHP
4753 N BROADWAY ST STE 700
CHICAGO, IL 60640-4995
Phone number: 773-293-8430
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Mailing Address
THIDAPORN IAMSUTTA QMHP
4753 N BROADWAY ST STE 700
CHICAGO, IL 60640-4995
Phone number: 773-293-8430
Copy
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