Individual
KATHY DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
904 E. MARTIN LUTHER KING JR. DRIVE, CENTRALIA, IL 62801-3058
(618) 533-1391
Mailing address
904 E. MARTIN LUTHER KING JR. DRIVE, CENTRALIA, IL 62801-3058
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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