Individual
JESSICA L HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
701 COLLEGE RD, LEBANON, IL 62254-1291
(618) 537-6929
Mailing address
440 VALLEY VW, CARLYLE, IL 62231-2306
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003463
IL
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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