Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | IL |
NPI | 1003219593 |
---|---|
Provider Name | Deandra Rangel |
First Address | Quincy, IL 62301-4446 |
Second Address | Quincy, IL 62301-2662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 23/10/2019 |