Individual
ANGELA MARIE HERBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
(618) 566-0313
Mailing address
814 DEER CREEK RD, O FALLON, IL 62269-4203
(509) 270-0228
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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