Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1896122 | IL |
Y | 103T00000X | Psychologist | 1896122 | IL |
NPI | 1013462415 |
---|---|
Provider Name | Emily Bailey |
First Address | Crystal Lake, IL 60014-8999 |
Second Address | Crystal Lake, IL 60014-8999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2016 |
Last Update Date | 16/08/2016 |