Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1023577046 |
---|---|
Provider Name | Kristin Brianne Geary |
First Address | Bradley, IL 60915-2091 |
Second Address | Bradley, IL 60915-2091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 12/01/2021 |