Individual
CARISSA WOODDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
1401 E 12TH ST, MENDOTA, IL 61342-9216
(815) 539-1409
Mailing address
26556 N 400 EAST RD, ANCONA, IL 61311-9805
(815) 992-0376
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146013301
IL
Other
Enumeration date
02/01/2019
Last updated
09/07/2023
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