Individual
AMANDA N GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 W MCMACKIN ST, SALEM, IL 62881-1724
(309) 531-3745
Mailing address
PO BOX 745, SALEM, IL 62881-0745
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
09/27/2018
Last updated
09/27/2018
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