Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180004976 | IL |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TS0200X | School Psychologist | 2149481 | IL |
NPI | 1093059081 |
---|---|
Provider Name | Dr. Ruth Myers-Vassell |
First Address | Blue Island, IL 60406-1111 |
Second Address | Chicago, IL 60615-4557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |