Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 071.008158 | IL |
NPI | 1093121931 |
---|---|
Provider Name | Dr. Sonya Jane Mathies Dinizulu |
First Address | Burr Ridge, IL 60527-7594 |
Second Address | Chicago, IL 60637-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 12/12/2014 |