Individual
JACOB LAYNE DELVALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1112 LINCOLNSHIRE DR, CHAMPAIGN, IL 61821-5606
(217) 637-0516
Mailing address
PO BOX 71, BROADLANDS, IL 61816-0071
(217) 637-0516
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
11/05/2009
Last updated
11/05/2009
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