Individual
MR. DOMYNIK MATTHEW MOWREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 SAINT LOUIS ST STE 1, EDWARDSVILLE, IL 62025-1979
(618) 226-4397
Mailing address
157 S MAIN ST, GLEN CARBON, IL 62034-1416
(618) 328-8044
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-286519
IL
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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