Provider Demographics
NPI:1366694309
Name:TRAN, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2619
Mailing Address - Country:US
Mailing Address - Phone:708-841-0347
Mailing Address - Fax:708-260-9396
Practice Address - Street 1:6 E MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2619
Practice Address - Country:US
Practice Address - Phone:708-841-0347
Practice Address - Fax:708-260-9396
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist