Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149006817 | IL |
NPI | 1003200981 |
---|---|
Provider Name | Ms. Jane Hansen |
First Address | Elgin, IL 60123-4404 |
Second Address | Elgin, IL 60123-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/03/2015 |