Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00344723 |
NPI | 1275285108 |
---|---|
Provider Name | Patrick Vickery |
First Address | Chicago, IL 60612-3728 |
Second Address | Chicago, IL 60612-3728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00344723 | IDPFR (01) |