Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1811325 | IL |
NPI | 1003331398 |
---|---|
Provider Name | Mary Elizabeth Wurster |
First Address | Romeoville, IL 60446-4330 |
Second Address | Romeoville, IL 60446-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326161522 | (05) | IL |