Organization
BELLEVILLE AREA SPECIAL SERVICES COOPERATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF DAUGHERTY (EXECUTIVE DIRECTOR)
(618) 355-4719
Entity
Organization
Contact information
Practice address
2411 PATHWAYS XING, BELLEVILLE, IL 62221-5885
(618) 355-4700
Mailing address
2411 PATHWAYS XING, BELLEVILLE, IL 62221-5885
(618) 355-4700
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
394137
IL
Other
Enumeration date
08/28/2017
Last updated
07/21/2022
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