Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | IL |
NPI | 1063680908 |
---|---|
Provider Name | Amy Allnutt |
First Address | Winfield, IL 60190-2041 |
Second Address | Winfield, IL 60190-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2008 |
Last Update Date | 13/02/2008 |