Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 178009491 | IL |
Y | 101YP2500X | Professional Counselor | 180012371 | IL |
N | 101YS0200X | School Counselor | 2235576 | IL |
NPI | 1164902219 |
---|---|
Provider Name | Dr. Kimberly Ann Hart |
First Address | Dekalb, IL 60115-7256 |
Second Address | Dekalb, IL 60115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 24/09/2021 |