Individual
JERRY CROCKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 W DIVISION ST, MANTENO, IL 60950-1065
(815) 432-5241
Mailing address
136 N ARBOR TRL, PARK FOREST, IL 60466-2604
(708) 513-3494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/18/2019
Last updated
03/17/2020
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