Individual
CHRISSIE NOELLE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
299 SWAN AVE, CENTRALIA, IL 62801-6127
(618) 533-4423
Mailing address
4920 CROSS RD, SALEM, IL 62881-7002
(618) 315-5492
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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