Individual
DEBRA DIANN TERFRUCHTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2001 WITHERS LN, BLOOMINGTON, IL 61704-9069
(309) 826-9252
Mailing address
2001 WITHERS LN, BLOOMINGTON, IL 61704-9069
(309) 826-9252
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.012849
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149.012849
LCSW LICENSE NUMBER
IL
Enumeration date
06/13/2020
Last updated
06/13/2020
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