Individual
TRACIE MICHELLE DONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1121 N 6TH ST, VANDALIA, IL 62471-1219
(618) 283-2222
Mailing address
1733 MOONGLOW RD, CENTRALIA, IL 62801-6767
(618) 335-6708
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/28/2019
Last updated
02/28/2019
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