Individual
DYLAN PATRICK PRENDERGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
(217) 352-3797
Mailing address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
(217) 352-3797
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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