Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 178009968 | IL |
NPI | 1003368739 |
---|---|
Provider Name | Christine Alexandra Espe Maxwell |
First Address | Dekalb, IL 60115-7109 |
Second Address | Dekalb, IL 60115-9637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2016 |
Last Update Date | 28/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
474579189001 | (05) | IL |