Provider Information for 1346907466
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YVONNE PETITO MA, LSW
Sex: Female
NPI: 1346907466
Last Updated: 2021-11-23
Certification Date: 2021-11-23
Certification Date: 2021-11-23
Details
Name | Value | ||||||||
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NPI | 1346907466 | ||||||||
Enumeration Date | 2021-11-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 988 N ILLINOIS ROUTE 3 WATERLOO, IL 62298-1059 United States Phone: 618-939-4444 | Fax: | ||||||||
Primary Practice Address | 988 N ILLINOIS ROUTE 3 WATERLOO, IL 62298-1059 United States Phone: 618-939-4444 | Fax: | ||||||||
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