Individual
DANIEL MIKEL CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
145 SPRINGFIELD CT, O FALLON, IL 62269-2495
(217) 525-8332
Mailing address
145 SPRINGFIELD CT, O FALLON, IL 62269-2495
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-37116
IL
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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