Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.012915 | IL |
NPI | 1003336629 |
---|---|
Provider Name | Cara Eliana Fisher Wellvang |
First Address | Evanston, IL 60201-3713 |
Second Address | Evanston, IL 60201-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2017 |
Last Update Date | 24/06/2017 |