Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1033691902 |
---|---|
Provider Name | Amy Bilow |
First Address | Riverside, IL 60546-2335 |
Second Address | Riverside, IL 60546-2335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2018 |
Last Update Date | 06/09/2018 |