Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149012887 | IL |
NPI | 1003052580 |
---|---|
Provider Name | Mr. John Anthony Knoerzer |
First Address | Chicago, IL 60625-6331 |
Second Address | Chicago, IL 60625-6331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 11/04/2011 |