Individual
STACIE N PETITGOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
652 E MAIN ST, CUBA, IL 61427-5211
(309) 785-8054
Mailing address
652 E MAIN ST, CUBA, IL 61427-5211
(309) 785-8054
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/04/2017
Last updated
07/21/2022
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