Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | ||
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics |
NPI | 1447902309 |
---|---|
Provider Name | Bonnie Durbin |
First Address | Granite City, IL 62040-4720 |
Second Address | Granite City, IL 62040-3429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |