Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1003321043 |
---|---|
Provider Name | Cesar Abraham Adrianzen |
First Address | Chicago, IL 60602-4309 |
Second Address | Chicago, IL 60602-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2017 |
Last Update Date | 13/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1817852 | ISBE (01) | IL |