Individual
JAELYN VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
2704 BOULDER DR, URBANA, IL 61802-6946
(217) 607-1678
Mailing address
2491 POTTERS TURN, KANKAKEE, IL 60901-7392
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
150.116036
IL
Other
Enumeration date
01/21/2025
Last updated
01/21/2025
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