Individual
CALEB RYAN STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4114 N WATER TOWER PL STE C, MOUNT VERNON, IL 62864-6548
(662) 882-8116
Mailing address
4294 BOSKYDELL RD, CARBONDALE, IL 62903-7611
(662) 882-8116
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-24990
IL
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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