Individual
COLE MARVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2255 N KENT RD, KENT, IL 61044-9625
(815) 904-4604
Mailing address
2255 N KENT RD, KENT, IL 61044-9625
(815) 904-4604
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149007305
IL
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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