Individual
CAROLYN MARIE GAYLORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2439
Mailing address
706 S STATE ST, B, CHAMPAIGN, IL 61820-8331
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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