Individual
CHIANTA A. JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
335 DAWN AVE APT 2, ROCKFORD, IL 61107-5047
(779) 300-3293
Mailing address
335 DAWN AVE APT 2, ROCKFORD, IL 61107-5047
(779) 300-3293
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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