| Light Way Aba Llc | |
|
15228 E Holland Dr Mount Vernon IL 62864-8604 | |
| (931) 278-2682 | |
| Not Available |
| Full Name | Light Way Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 15228 E Holland Dr, Mount Vernon, Illinois |
| Authorized Official Name and Position | Katelyn Legere (OWNER) |
| Authorized Official Contact | 9312782682 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Way Aba Llc 15228 E Holland Dr Mount Vernon IL 62864-8604 Ph: (931) 278-2682 | Light Way Aba Llc 15228 E Holland Dr Mount Vernon IL 62864-8604 Ph: (931) 278-2682 |
| NPI Number | 1669226973 |
|---|---|
| Provider Enumeration Date | 04/15/2024 |
| Last Update Date | 04/15/2024 |
| Certification Date | 04/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669226973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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