Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1093473506 |
---|---|
Provider Name | Mr. Zanu Gordon |
First Address | Chicago, IL 60602-4309 |
Second Address | Chicago, IL 60602-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2021 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2453303 | ISBE (01) | IL |