Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003568338 |
---|---|
Provider Name | Kelly M Corona |
First Address | Aurora, IL 60506-2411 |
Second Address | Aurora, IL 60506-2411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2022 |
Last Update Date | 18/01/2022 |