Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 150013629 | IL |
NPI | 1003169780 |
---|---|
Provider Name | Jennifer M Vergara |
First Address | Barrington, IL 60010-4168 |
Second Address | Rolling Meadows, IL 60008-4426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
362815350 | BARRINGTON YOUTH & FAMILY SERVICES (01) | IL |