Individual
JEPHTHAT MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 S GRACE ST APT 605, LOMBARD, IL 60148-5514
(312) 709-5351
Mailing address
1001 ROHLWING RD, ELK GROVE VLG, IL 60007-3217
(312) 709-5351
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/06/2023
Last updated
10/06/2023
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