Individual
CAROL LYNN MCCRARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
521 E 2ND ST, CENTRALIA, IL 62801-3514
(618) 322-6296
(618) 532-8296
Mailing address
521 E 2ND ST, CENTRALIA, IL 62801-3514
(618) 322-6296
(618) 532-8296
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222Q00000X
EARLY INTERVENTION PROVIDER
IL
Enumeration date
09/06/2012
Last updated
09/06/2012
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