Individual
MISS ALLEANA MICAELA MAGLAQUE FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
5230 6TH STREET FRONTAGE RD E, SPRINGFIELD, IL 62703-5128
(217) 585-4700
Mailing address
5230 6TH STREET FRONTAGE RD E, SPRINGFIELD, IL 62703-5128
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
03/06/2018
Last updated
06/16/2018
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