Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003494758 |
---|---|
Provider Name | Kimberly Ann Payton |
First Address | Mchenry, IL 60050-8377 |
Second Address | Mchenry, IL 60050-8377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 01/04/2021 |