Individual
NICOLE CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 5TH AVE, BELVIDERE, IL 61008-5125
(815) 544-0301
Mailing address
1201 5TH AVE, BELVIDERE, IL 61008-5125
(815) 544-0301
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811165061
BELVIDERE CUSD #100
IL
Enumeration date
12/08/2017
Last updated
12/08/2017
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