Individual
KELSEY RENAE BECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 E BIRCH ST, MOWEAQUA, IL 62550-1302
(217) 855-8867
Mailing address
112 E BIRCH ST, MOWEAQUA, IL 62550-1302
(217) 855-8867
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
B20051682790
IL
Other
Enumeration date
06/14/2013
Last updated
06/14/2013
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