Individual
DYNASTY DONMINIK ROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 GLEN CROSSING RD, GLEN CARBON, IL 62034-1405
(618) 857-0106
Mailing address
117 GLEN CROSSING RD, GLEN CARBON, IL 62034-1405
(618) 857-0106
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-394965
IL
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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