Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | IL |
NPI | 1023789617 |
---|---|
Provider Name | Lauren Elizabeth Carr |
First Address | Chicago, IL 60657-5147 |
Second Address | Chicago, IL 60657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 23/09/2021 |