Individual
MR. JUSTIN BARTLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
631 S 1ST ST, DEKALB, IL 60115-4117
(815) 756-8501
Mailing address
631 S 1ST ST, DEKALB, IL 60115-4117
(815) 756-8501
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4745791809001
—
IL
Enumeration date
11/15/2016
Last updated
11/15/2016
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