Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2022-06-01
- Last updated
- 2022-07-27
Specialties
Licenses
- License IL
- RBT-22-218009
Location
- Practice location
- 742 ESSINGTON RD
- City
- JOLIET IL
- Postal code
- 604354912
- Phone
- 815-220-5632
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.