Individual
MS. CARLY MARIE KUPERSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 N RUSSELL AVE, GENESEO, IL 61254-2044
(309) 945-0625
Mailing address
310 20TH AVE W, MILAN, IL 61264-3365
(815) 990-6803
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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