Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 036110488 | IL |
N | 103T00000X | Psychologist | 036110488 | IL |
NPI | 1013102771 |
---|---|
Provider Name | Farah Naz Pathan |
First Address | Rockford, IL 61107-1822 |
Second Address | Rockford, IL 61107-1822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110488 | (05) | IL |