Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16571 | IL |
Y | 1041C0700X | Clinical Social Worker | 149.017895 | IL |
NPI | 1003269929 |
---|---|
Provider Name | Ms. Lisa F Hartman |
First Address | Buffalo Grove, IL 60089-1436 |
Second Address | Buffalo Grove, IL 60089-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 15/07/2016 |