Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 102442 | IL |
NPI | 1033635594 |
---|---|
Provider Name | Dr. Christine Ellen Mitchell-Endsley |
First Address | Belleville, IL 62221-5885 |
Second Address | Belleville, IL 62221-5885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |