Provider Demographics
NPI:1851505762
Name:SERIO, JOANNE RUTH (DT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:RUTH
Last Name:SERIO
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12759 W BEAVER DEN TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9025
Mailing Address - Country:US
Mailing Address - Phone:708-301-5137
Mailing Address - Fax:708-301-0394
Practice Address - Street 1:12759 W BEAVER DEN TRL
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9025
Practice Address - Country:US
Practice Address - Phone:708-301-5137
Practice Address - Fax:708-301-0394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL199OtherDEVELOPMENTAL THERAPIST