| NPI | 1417051020 |
|---|---|
| Former Name | JENNIFER LEE BANG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180009117) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.009117) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2016-12-23 |