Individual
GWENETTA J DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 EAGLE CRK, COLLINSVILLE, IL 62234-4395
(314) 933-6369
Mailing address
100 EAGLE CRK, COLLINSVILLE, IL 62234-4395
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227018739
IL
Other
Enumeration date
03/05/2018
Last updated
03/05/2018
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