Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1013403922 |
---|---|
Provider Name | Haile Pollard-Durodola |
First Address | Chicago, IL 60625-7121 |
Second Address | Chicago, IL 60612-3534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 03/07/2018 |