Individual
KATHRYN ROSE CULLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17256 NEW DENNISON RD, MARION, IL 62959-6220
(618) 364-6808
Mailing address
17256 NEW DENNISON RD, MARION, IL 62959-6220
(618) 364-6808
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SYG125146001001
BLUE CROSS BLUE SHIELD INSURANCE
IL
Enumeration date
12/14/2021
Last updated
12/14/2021
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