Most Relevant Information
Provider Data
| NPI Number: | 1003478579 |
| Provider Name: | ELIZABETH MARDIS |
| Entity Type: | Individual |
| Taxonomy Code: | 222Q00000X |
| Specialty: | Developmental Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/03/2019 |
| Last Updated: | 07/03/2019 |
Provider Practice Location
6132 S VERNON AVE # 2N
CHICAGO
IL
606372318
Practice Location Phone/Fax
| Phone: | 8722129416 |
| Fax: |
Provider Mailing Location
6132 S VERNON AVE # 2N
CHICAGO
IL
606372318
Provider Mailing Phone/Fax
| Phone: | 8722129416 |
| Fax: |