Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.011476 | IL |
NPI | 1003361247 |
---|---|
Provider Name | Emma Macdougall |
First Address | Chicago, IL 60640-1125 |
Second Address | Chicago, IL 60640-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2016 |
Last Update Date | 17/08/2016 |