Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.012508 | IL |
NPI | 1003248980 |
---|---|
Provider Name | Miriam Klevan |
First Address | Chicago, IL 60622-1813 |
Second Address | Chicago, IL 60622-1813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2013 |
Last Update Date | 02/08/2013 |