Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17-36284 | IL |
NPI | 1003305590 |
---|---|
Provider Name | Mrs. Gloria Jean Erick |
First Address | Palos Hills, IL 60465-2054 |
Second Address | Palos Hills, IL 60465-2054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 09/05/2018 |