Individual
MISS DAISY MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 W SPRINGFIELD AVE, CHAMPAIGN, IL 61820-4716
(224) 489-6080
Mailing address
108 E HEALEY ST APT 12, CHAMPAIGN, IL 61820-5340
(224) 489-6080
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
IL
Other
Enumeration date
02/03/2007
Last updated
07/08/2007
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