Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114153491 |
---|---|
Provider Name | Lori S Mitchell |
First Address | Savoy, IL 61874-9666 |
Second Address | Champaign, IL 61820-7236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 01/06/2009 |