Individual
CARLOS LEE VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4108 FIELDSTONE RD, CHAMPAIGN, IL 61822-8817
(847) 942-7159
Mailing address
4108 FIELDSTONE RD, CHAMPAIGN, IL 61822-8817
(847) 942-7159
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB681486
IL
Other
Enumeration date
03/19/2025
Last updated
03/19/2025
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