Individual
KAHLEY GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 E PARK ST STE 106, CHAMPAIGN, IL 61820-3862
(217) 714-7042
Mailing address
1601 N LINCOLN AVE, URBANA, IL 61801-1018
(708) 573-2874
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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