Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | IL |
NPI | 1003361700 |
---|---|
Provider Name | Emily Gerber |
First Address | Gibson City, IL 60936-1477 |
Second Address | Gibson City, IL 60936-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370647938 | (05) | IL |