Organization
JEANINE STANDARD METAMORPHOSIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANINE RENE STANDARD PH.D. (LICENSED CLINICAL PSYCHOLOGIST)
(309) 740-2171
Entity
Organization
Contact information
Practice address
8 S MAIN ST, SUITE 205, CANTON, IL 61520-2677
(309) 740-2171
(309) 740-2171
Mailing address
8 S MAIN ST, SUITE 205, CANTON, IL 61520-2677
(309) 740-2171
(309) 740-2171
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007101
IL
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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