Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1629692280 |
---|---|
Provider Name | Rachel Anne Brokenshire |
First Address | Westchester, IL 60154-5106 |
Second Address | Westchester, IL 60154-5106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2020 |
Last Update Date | 29/05/2020 |