Individual
JAZMINE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 SPRINGFIELD AVE, CHAMPAIGN, IL 61821
(217) 398-8464
Mailing address
801 N WALNUT ST, CHAMPAIGN, IL 61820-3055
(217) 398-8464
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W420-4329-4971
—
IL
Enumeration date
02/16/2023
Last updated
02/16/2023
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