Individual
MS. ELISA RENEE JELLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.PC
Contact information
Practice address
30 GRAINEY DR, GLEN CARBON, IL 62034-3217
(618) 205-3615
Mailing address
30 GRAINEY DR, GLEN CARBON, IL 62034-3217
(618) 205-3615
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2009009733
MO
Other
Enumeration date
12/02/2009
Last updated
12/02/2009
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