Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149018325 | IL |
NPI | 1003227422 |
---|---|
Provider Name | Ms. Jennifer Mcnair |
First Address | Champaign, IL 61822-6814 |
Second Address | Champaign, IL 61822-6814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 28/07/2016 |