Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178011187 | IL |
N | 101YS0200X | School Counselor | 1001524 | IL |
NPI | 1235669763 |
---|---|
Provider Name | Elizabeth Lassandrello Bremner |
First Address | Oswego, IL 60543-8297 |
Second Address | Oswego, IL 60543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |