Individual
KELLY LYNN MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 S HENRY ST, ASHKUM, IL 60911-7119
(815) 370-0910
Mailing address
301 S HENRY ST, ASHKUM, IL 60911-7119
(815) 370-0910
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178012643
IL
Other
Enumeration date
10/15/2020
Last updated
03/17/2022
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