Individual
JENNIFER LYNN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5220 6TH STREET FRONTAGE RD E, SPRINGFIELD, IL 62703-5735
(217) 553-7899
Mailing address
5220 6TH STREET FRONTAGE RD E, SPRINGFIELD, IL 62703-5735
(217) 553-7899
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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