Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103G00000X | Clinical Psychologist | 071010264 | IL |
N | 103TC0700X | Clinical Psychologist | 071010264 | IL |
NPI | 1003393489 |
---|---|
Provider Name | Elizabeth Culnan |
First Address | Chicago, IL 60612-3808 |
Second Address | Chicago, IL 60612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 05/06/2020 |