Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1001538 | IL |
NPI | 1043723091 |
---|---|
Provider Name | Mrs. Monica Vidal |
First Address | Des Plaines, IL 60018-3843 |
Second Address | Des Plaines, IL 60018-3843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |