DAISY POLK

ROCKFORD, IL
NPI1356831416
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy106S00000X Behavior Technician
(Licence: IL  17-38594)
Enumeration Date2018-05-15
Last Update Date2018-05-15
Business Address
DAISY POLK
2804 CONKLIN DR APT 7
ROCKFORD, IL 61101-1885
Phone number: 815-978-0672
Mailing Address
DAISY POLK
2804 CONKLIN DR APT 7
ROCKFORD, IL 61101-1885
Phone number:
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