Individual
DESTINY MARIE WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
188 W ILLINOIS HWY, NEW LENOX, IL 60451-5501
(779) 803-1373
Mailing address
188 W ILLINOIS HWY, NEW LENOX, IL 60451-5501
(779) 803-1373
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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