NPI | 1245521780 |
---|---|
Former Name | JENIFER CORINNE KOROTKO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180008029) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.006913) |
Enumeration Date | 2011-05-02 |
Last Update Date | 2020-12-02 |