Individual
MR. KEITH DRISCOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.HD
Contact information
Practice address
1207 S ELM ST, CENTRALIA, IL 62801
(618) 579-9072
Mailing address
1207 S ELM ST, CENTRALIA, IL 62801-4738
(618) 579-9072
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
601986842
WA
Other
Enumeration date
10/27/2011
Last updated
11/21/2018
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