Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1780917096 |
---|---|
Provider Name | Ms. Brenda Dorene Richardson |
First Address | Chicago, IL 60617-1115 |
Second Address | Chicago, IL 60617-1115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2009 |
Last Update Date | 18/09/2009 |