Individual
KEIONI WIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
(618) 566-0313
Mailing address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-17-35650
N/A
IL
Enumeration date
02/15/2018
Last updated
02/15/2018
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