Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003294372 |
---|---|
Provider Name | Carolyn Stopka |
First Address | Elk Grove Village, IL 60007-4456 |
Second Address | Elk Grove Village, IL 60007-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/05/2015 |