Individual
JEANETTE LYNN MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
423 W GRANT ST, STILLMAN VALLEY, IL 61084-8998
(618) 713-7817
Mailing address
423 W GRANT ST, STILLMAN VALLEY, IL 61084-8998
(618) 713-7817
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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