Individual
CARLA MICHELLE BURDETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1805 ESIC DR, EDWARDSVILLE, IL 62025-3945
(618) 973-6930
Mailing address
1805 ESIC DR, EDWARDSVILLE, IL 62025-3945
(618) 973-6930
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1815705
IL
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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