Individual
GRACE C WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
115 ROTTINGHAM CT STE A, EDWARDSVILLE, IL 62025-3677
(866) 522-2467
(217) 789-1420
Mailing address
5220 6TH STREET FRONTAGE RD E STE 1700, SPRINGFIELD, IL 62703-5771
(217) 525-8332
(217) 789-1420
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/13/2018
Last updated
06/13/2018
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