Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 765573 | IL |
NPI | 1033606413 |
---|---|
Provider Name | Mr. Nathan Thomas Vent |
First Address | Matteson, IL 60443-1111 |
Second Address | Matteson, IL 60443-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2018 |
Last Update Date | 20/04/2018 |