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Individual

HOLLI DANEL HODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14495 N MCCAULEY LN, MOUNT VERNON, IL 62864-7970
(217) 508-6766
Mailing address
14495 NTH MCCAULEY LANE, MOUNT VERNON, IL 62864
(217) 508-6766

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary

Other

Enumeration date
02/24/2017
Last updated
02/24/2017
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