Individual
ALLYSON CORRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
(618) 566-0313
Mailing address
4 PINTAIL DRIVE, CARLYLE, IL 62231
(618) 910-2037
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-67232
IL
Other
Enumeration date
10/05/2018
Last updated
10/05/2018
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