| Idjj Sd#428 | |
|
1220 Centreville Ave Fl 2 Belleville IL 62220-3089 | |
| (618) 222-3148 | |
| Not Available |
| Full Name | Idjj Sd#428 |
|---|---|
| Speciality | Psychologist - School |
| Location | 1220 Centreville Ave Fl 2, Belleville, Illinois |
| Authorized Official Name and Position | Bambi Bethel-leitschuh (DIRECTOR OF SPECIAL EDUCATION) |
| Authorized Official Contact | 6182223148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idjj Sd#428 1220 Centreville Ave Fl 2 Belleville IL 62220-3089 Ph: () - | Idjj Sd#428 1220 Centreville Ave Fl 2 Belleville IL 62220-3089 Ph: (618) 222-3148 |
| NPI Number | 1255977757 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 11/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255977757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TS0200X | Psychologist - School | (* (Not Available)) | Primary |
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