Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071007307 | IL |
Y | 103TC0700X | Clinical Psychologist | 071007307 | IL |
NPI | 1003325887 |
---|---|
Provider Name | Dr. Michele Womontree |
First Address | Hillsboro, IL 62049 |
Second Address | Hillsboro, IL 62049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 25/09/2017 |