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Mallori Wilson
NPI 1740455732 · on the registry since 2008 · sole proprietor
Practice
- Address
- 14341 Allen Rd
Herrin, IL 62948 - Phone
- (618) 559-6377
Registry record
- Primary taxonomy
- 225100000X
225100000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2011-01-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois