Individual
DUSTIN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
502 HOLLY PL, SALEM, IL 62881-1237
(618) 315-4533
Mailing address
502 HOLLY PL, SALEM, IL 62881-1237
(618) 315-4533
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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