Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.008116 | IL |
NPI | 1003259938 |
---|---|
Provider Name | Margaret Smith |
First Address | Waukegan, IL 60085-6419 |
Second Address | Buffalo Grove, IL 60089-6547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 10/04/2013 |