Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 887470 | IL |
NPI | 1033628524 |
---|---|
Provider Name | Melissa Caby |
First Address | Riverside, IL 60546-1633 |
Second Address | Riverside, IL 60546-1633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 27/09/2017 |