Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071007453 | IL |
Y | 103TC0700X | Clinical Psychologist | 071007453 | IL |
NPI | 1003075979 |
---|---|
Provider Name | Dr. Rebecca Wynne Denosaquo |
First Address | Mount Prospect, IL 60056-1927 |
Second Address | Winnetka, IL 60093-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 17/08/2015 |