Individual
DOMINIQUE WOODHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-0701
Mailing address
4109 ABINGER PL, BELLEVILLE, IL 62226-7855
(618) 401-2328
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IL
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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