Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1063925014 |
---|---|
Provider Name | Katerina Diane Vaselopulos |
First Address | Des Plaines, IL 60016-6251 |
Second Address | Des Plaines, IL 60016-6251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194859975 | SCHOOL DISTRICT (01) | IL |