Individual
MISS MARY ANASTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1204 E OAK ST STE 2-2, MAHOMET, IL 61853-2795
(217) 530-5608
(309) 981-8714
Mailing address
1204 E OAK ST STE 2-2, MAHOMET, IL 61853-2795
(217) 530-5608
(309) 981-8714
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150108984
IL
Other
Enumeration date
09/27/2022
Last updated
09/27/2022
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