Individual
MARY LYNN O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N 8TH ST STE 4A, SPRINGFIELD, IL 62701-1013
(217) 545-8000
(217) 545-5018
Mailing address
PO BOX 19658, SPRINGFIELD, IL 62794-9658
(217) 545-8000
(217) 545-5018
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
246-000378
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246-000378
IL LICENSE
IL
Enumeration date
08/30/2018
Last updated
08/30/2018
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