Individual
JESSICA AINSWORTH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2031 S ILLINOIS AVE, CARBONDALE, IL 62903-5909
(618) 457-7732
Mailing address
53 LAKESIDE DR, MAKANDA, IL 62958-2639
(217) 972-8259
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.013773
IL
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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