Individual
JAMIE LAURSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2416 E WASHINGTON STREET, #A3, BLOOMINGTON, IL 61704
(309) 242-3975
Mailing address
2416 E WASHINGTON STREET, #A3, BLOOMINGTON, IL 61704
(309) 242-3975
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.006977
IL
Other
Enumeration date
07/18/2011
Last updated
10/05/2021
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