Individual
LA SHAWN RAYNARD STALLWORTH I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1630 PLUM ST, AURORA, IL 60506-3462
(630) 966-4475
Mailing address
1630 PLUM ST, AURORA, IL 60506-3462
(630) 966-4475
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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