Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1184297392 |
---|---|
Provider Name | Mr. Matthew D Patton |
First Address | Naperville, IL 60565-1368 |
Second Address | Naperville, IL 60565-1368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |