Individual
CHANEL TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 PEARSON, BENTON, AR 72015-4436
(501) 315-4224
(501) 778-0450
Mailing address
112 PEARSON, BENTON, AR 72015-4436
(501) 315-4224
(501) 778-0450
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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