Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180000582 | IL |
NPI | 1003326752 |
---|---|
Provider Name | Phyllis Glazer |
First Address | Palos Heights, IL 60463-1154 |
Second Address | Palos Heights, IL 60463-1154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2017 |
Last Update Date | 09/10/2017 |