Individual
DANIELLE DITTERLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6 EAGLE CTR STE 1, O FALLON, IL 62269-1945
(618) 206-8816
Mailing address
6208 ISABEL ST, GODFREY, IL 62035-2410
(618) 803-5000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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