Individual
COLLEENA SUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2990 N PERRYVILLE RD UNIT 1100, ROCKFORD, IL 61107-6827
(815) 469-1500
Mailing address
9500 BORMET DR STE 304, MOKENA, IL 60448-8399
(815) 469-1500
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-74573
IL
103K00000X
Behavior Analyst
Primary
152.000089
IL
Other
Enumeration date
03/15/2019
Last updated
05/12/2026
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