Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 33015 | IL |
NPI | 1003277047 |
---|---|
Provider Name | Katherine Kereszturi |
First Address | Cicero, IL 60804-1230 |
Second Address | Chicago, IL 60609-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 18/03/2016 |