NPI | 1205331386 |
---|---|
Former Name | STEPHANIE LEE WILLMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178913472.) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 178013472) |
101YP2500X Counselor, Professional (Licence: IL 178013472) | |
Enumeration Date | 2018-03-29 |
Last Update Date | 2023-01-04 |