Individual
MARY GIENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1530 LINCOLN AVE, CHARLESTON, IL 61920-3057
(217) 348-0127
Mailing address
1530 LINCOLN AVE, CHARLESTON, IL 61920-3057
(217) 348-0127
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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