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ALEXIS PENNACCHIO BENAVENTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
B.S.

Contact information

Practice address
614 W HEALEY ST, CHAMPAIGN, IL 61820-5025
(217) 398-1658
Mailing address
614 W HEALEY ST, CHAMPAIGN, IL 61820-5025
(217) 398-1658

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Enumeration date
06/29/2011
Last updated
06/29/2011
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