Individual
JENNIFER DONNELL DIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6 EAGLE CTR, O FALLON, IL 62269-1945
(618) 206-8816
Mailing address
218 COVENTRY PL APT E, EDWARDSVILLE, IL 62025-1571
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
11/27/2023
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