Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 150013431 | IL |
NPI | 1003189051 |
---|---|
Provider Name | Jennifer L Weber |
First Address | Dekalb, IL 60115-9637 |
Second Address | Dekalb, IL 60115-9637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |