Individual
MRS. KELLY SUE WILLENBORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA IN GERONTOLOGY
Contact information
Practice address
300 SUR WOODS DR, EFFINGHAM, IL 62401-3113
(217) 254-2149
Mailing address
604 E JEFFERSON AVE, EFFINGHAM, IL 62401-3405
(217) 254-2149
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
225C00000X
Rehabilitation Counselor
Primary
—
IL
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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