| NPI | 1942503800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: IL 2064983) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 2064983) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IN 2064983) | |
| 172A00000X Driver (Licence: IL 2064983) | |
| 172V00000X Community Health Worker (Licence: IL 2064983) | |
| 174400000X Specialist (Licence: IL 2064983) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |