Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 2299795 | IL |
NPI | 1124364963 |
---|---|
Provider Name | Ms. Juanita Louise Smith |
First Address | Crete, IL 60417-1329 |
Second Address | Crete, IL 60417-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2012 |
Last Update Date | 26/12/2012 |