Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.016552 | IL |
NPI | 1003228826 |
---|---|
Provider Name | Mrs. Trevaughn Davis-Neal |
First Address | Harvey, IL 60426-5204 |
Second Address | Harvey, IL 60426-5204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 28/05/2014 |