Individual
JSON S WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 ROTTINGHAM CT STE A, EDWARDSVILLE, IL 62025-3677
(866) 522-2467
Mailing address
115 ROTTINGHAM CT STE A, EDWARDSVILLE, IL 62025-3677
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-99230
IL
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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