Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003292178 |
---|---|
Provider Name | Patricia D'ambrose |
First Address | Naperville, IL 60564-5877 |
Second Address | Lombard, IL 60148-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 30/07/2015 |