JACKIE RENAE WIEDUWILT Athletic Trainer License verification

Business Entity

NOT RENEWED

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096001513

License Status

NOT RENEWED

Business

First Name

JACKIE

Middle

RENAE

Last Name

WIEDUWILT

Business Name

JACKIE RENAE WIEDUWILT

Original Issue Date

07/09/2001

Effective Date

03/19/2014

Expiration Date

05/31/2016

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/11/2016