Individual
KRISTINE WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
505 S 25TH ST, SOUTH BEND, IN 46615-2117
(574) 217-5997
Mailing address
505 S 25TH ST, SOUTH BEND, IN 46615-2117
(574) 217-5997
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
Primary
—
—
Other
Enumeration date
03/29/2020
Last updated
03/29/2020
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