Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 180.010289 | IL |
NPI | 1003180258 |
---|---|
Provider Name | Ms. Erin Redfern |
First Address | Bloomingdale, IL 60108 |
Second Address | Bloomingdale, IL 60108-1597 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 23/07/2017 |