Individual
ALEXA NUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 W CLARK ST, CHAMPAIGN, IL 61820-4637
(217) 398-9066
(217) 398-9077
Mailing address
309 W CLARK ST, CHAMPAIGN, IL 61820-4637
(217) 398-9066
(217) 389-9077
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178-016699
IL
Other
Enumeration date
03/22/2021
Last updated
03/28/2023
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