Individual
GRACE KATHLEEN FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
343 FOUNTAINS PKWY UNIT 201, FAIRVIEW HEIGHTS, IL 62208-2170
(618) 515-1441
(618) 551-4711
Mailing address
343 FOUNTAINS PKWY UNIT 201, FAIRVIEW HEIGHTS, IL 62208-2170
(618) 515-1441
(618) 551-4711
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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