| NPI | 1174921514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY JOE WIEGAND Neurotherapist 309-369-8832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZE0500X Specialist/Technologist, Other, EEG |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| 106H00000X Marriage & Family Therapist (Licence: MO 2013031915) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2014-12-30 |