Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2406585 | IL |
NPI | 1043809825 |
---|---|
Provider Name | Ms. Angie Christina Dolosic |
First Address | Collinsville, IL 62234-2314 |
Second Address | O Fallon, IL 62269-6841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2021 |
Last Update Date | 15/01/2021 |