Individual
DR. ALEXANDER PERRY WILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
808 S ELDORADO RD STE 102, BLOOMINGTON, IL 61704-6075
(309) 706-3190
(309) 588-4115
Mailing address
808 S ELDORADO RD STE 102, BLOOMINGTON, IL 61704-6075
(309) 706-3190
(309) 588-4115
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071009688
IL
103TC0700X
Clinical Psychologist
071009688
IL
Other
Enumeration date
12/28/2017
Last updated
12/28/2017
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