Individual
MRS. JANET A RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
650 N MAIN ST, ROCKFORD, IL 61103-6921
(815) 965-6745
(815) 968-9563
Mailing address
4201 VIRGINIA AVE, ROCKFORD, IL 61101-4954
(815) 520-5857
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/06/2007
Last updated
07/08/2007
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