Provider Demographics
NPI:1518390871
Name:ENRIQUEZ, MARY SOL
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SOL
Last Name:ENRIQUEZ
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 1:11307 W EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60087-1526
Mailing Address - Country:US
Mailing Address - Phone:847-275-4064
Mailing Address - Fax:
Practice Address - Street 1:11307 W EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60087-1526
Practice Address - Country:US
Practice Address - Phone:847-275-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist