Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor |
NPI | 1104030139 |
---|---|
Provider Name | Kenyetta N. Broughton-Floyd |
First Address | Park Forest, IL 60466-0992 |
Second Address | Park Forest, IL 60466-2013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |