Individual
MS. MARY JO RENZAGLIA-WEIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1000
(618) 939-4444
Mailing address
988 N ILLINOIS ROUTE 3, PO BOX 146, WATERLOO, IL 62298-1000
(618) 939-4444
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1020845
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370968305
—
IL
Enumeration date
03/21/2017
Last updated
03/21/2017
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