Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 150012187 | IL |
NPI | 1003117144 |
---|---|
Provider Name | Raquel Teresa Reyes |
First Address | Hines, IL 60141-3030 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 05/11/2010 |