Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2002627 | IL |
NPI | 1003324567 |
---|---|
Provider Name | Marta J Polka |
First Address | Arlington Heights, IL 60005-3657 |
Second Address | Wheeling, IL 60090-3986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 18/01/2018 |