Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.014925 | IL |
NPI | 1003053547 |
---|---|
Provider Name | Ms. Barbara A Ladd |
First Address | Crystal Lake, IL 60014-8716 |
Second Address | Crystal Lake, IL 60014-8716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 01/10/2012 |