Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180012044 | IL |
NPI | 1003380817 |
---|---|
Provider Name | Anna Tornquist |
First Address | Chicago, IL 60623-2460 |
Second Address | Chicago, IL 60623-2460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |