Most Relevant Information
Provider Data
| NPI Number: | 1003540576 |
| Provider Name: | TINA M JEROLDS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 149.010409 |
Most Important Dates
| Enumeration Date: | 07/12/2022 |
| Last Updated: | 07/12/2022 |
Provider Practice Location
15 GREEN ACRES LN
JONESBORO
IL
629521325
Practice Location Phone/Fax
| Phone: | 6186973834 |
| Fax: |
Provider Mailing Location
15 GREEN ACRES LN
JONESBORO
IL
629521325
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |