Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.002935 | IL |
N | 101YS0200X | School Counselor | 2074546 | IL |
NPI | 1104282151 |
---|---|
Provider Name | Cynthia (cindy) Dawn Willard |
First Address | Rock Island, IL 61201-5351 |
Second Address | Rock Island, IL 61201-5351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2016 |
Last Update Date | 06/01/2016 |