Individual
KIMBERLY GAYE TENNYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
RR 3 BOX 792, FAIRFIELD, IL 62837-9598
(618) 897-2430
(618) 897-2441
Mailing address
RR 3 BOX 792, FAIRFIELD, IL 62837-9598
(618) 897-2430
(618) 897-2441
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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