Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003315284 |
---|---|
Provider Name | Ms. Emisa Bell |
First Address | Chicago, IL 60615-2433 |
Second Address | Cicero, IL 60804-3956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 02/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1649404716 | UCP SEGUIN (01) | IL |