Individual
VICKY COCHRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3248 VANDEVER AVE, PEKIN, IL 61554-6274
(309) 347-5579
Mailing address
3248 VANDEVER AVE, PEKIN, IL 61554-6274
(309) 347-5579
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
TAXONOMY
—
Enumeration date
05/19/2021
Last updated
05/19/2021
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