Individual
ALI GRACE DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21 IVEY CT, BLOOMINGTON, IL 61701-7851
(309) 634-6749
Mailing address
21 IVEY CT, BLOOMINGTON, IL 61701-7851
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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