Individual
MADILYN ANN LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3113 SQUALL WAY APT 212, BLOOMINGTON, IL 61704-8495
(217) 972-3571
Mailing address
3113 SQUALL WAY APT 212, BLOOMINGTON, IL 61704-8495
(217) 972-3571
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/24/2018
Last updated
03/24/2018
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