Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003189143 |
---|---|
Provider Name | Amy Bossman |
First Address | Wheaton, IL 60187-3977 |
Second Address | Addison, IL 60101-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |