Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1356524045 |
---|---|
Provider Name | Mr. Victor H Dietz |
First Address | Glen Ellyn, IL 60137-6280 |
Second Address | Glen Ellyn, IL 60137-6280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 17/12/2007 |