Individual
DIANE L MCKILLOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MARKET ST, BLOOMINGTON, IL 61701
(309) 827-5351
(309) 829-6808
Mailing address
19316 INVERNESS CT, BLOOMINGTON, IL 61704
(309) 838-9274
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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