Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1053970848 |
---|---|
Provider Name | Jennie Probst |
First Address | Manhattan, IL 60442-9511 |
Second Address | Manhattan, IL 60442-9511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/06/2019 |