Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16606 | IL |
N | 1041C0700X | Clinical Social Worker | IL |
NPI | 1003998204 |
---|---|
Provider Name | Mrs. Lynn Wachtel Shapiro |
First Address | Tinley Park, IL 60477 |
Second Address | Tinley Park, IL 60477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |