Individual
JOANNA RAE MALMQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 HEATHERVIEW DR, EAST PEORIA, IL 61611-4889
(309) 360-0707
Mailing address
112 HEATHERVIEW DR, EAST PEORIA, IL 61611-4889
(309) 360-0707
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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