Individual
ASHLEY PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1630 S STATE ST, SPRINGFIELD, IL 62704-3682
(217) 528-3694
Mailing address
617 W WOODLAND AVE, SPRINGFIELD, IL 62704-2834
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178018417
IL
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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