Search › Illinois › 347C00000X
Telisa Long
NPI 1285866111 · on the registry since 2009 · sole proprietor
Practice
- Address
- 413 Indianwood Blvd
Park Forest, IL 60466 - Phone
- (708) 369-2368
- Fax
- (708) 747-5980
Registry record
- Primary taxonomy
- 347C00000X
347C00000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2009-08-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois