Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180009667 | IL |
NPI | 1003167578 |
---|---|
Provider Name | Mrs. Camila Salvisberg |
First Address | Chicago, IL 60611-3783 |
Second Address | Chicago, IL 60611-3783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 17/05/2017 |