Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003325556 |
---|---|
Provider Name | Elmo Painter |
First Address | Chicago, IL 60659-3324 |
Second Address | Chicago, IL 60659-3324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 27/09/2017 |