Individual
KENNEDY CLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
343 FOUNTAINS PKWY STE 201, FAIRVIEW HEIGHTS, IL 62208-2170
(618) 515-1441
Mailing address
343 FOUNTAINS PKWY STE 201, FAIRVIEW HEIGHTS, IL 62208-2170
(618) 515-1441
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-173580
IL
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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