Individual
MRS. JILLIAN RENEE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 W 6TH ST, BENTON, IL 62812-1247
(815) 600-3078
Mailing address
401 W 6TH ST, BENTON, IL 62812-1247
(815) 600-3078
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
05/08/2012
Last updated
05/08/2012
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