Individual
MRS. KATHLEEN A HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
506 N TOWN AVE, PRINCEVILLE, IL 61559-9761
(306) 686-1177
(309) 686-7722
Mailing address
506 N TOWN AVE, PRINCEVILLE, IL 61559-9761
(306) 686-1177
(309) 686-7722
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37-0686250001
—
IL
Enumeration date
03/18/2009
Last updated
03/18/2009
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