Individual
JESSICA ELIZABETH WILLMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
14615 MANCHESTER RD, SUITE 204, BALLWIN, MO 63011-3790
(314) 488-2019
Mailing address
1004 POWELL AVE, COLLINSVILLE, IL 62234-3136
(618) 980-2332
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2011031450
MO
Other
Enumeration date
02/24/2012
Last updated
05/19/2015
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