Individual
EBONIE DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
517 W TOWN CENTER BLVD, CHAMPAIGN, IL 61822-1248
(630) 359-3629
Mailing address
517 W TOWN CENTER BLVD, CHAMPAIGN, IL 61822-1248
(630) 359-3629
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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