Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1366070377 |
---|---|
Provider Name | Ruth Stone |
First Address | Tinley Park, IL 60477-3936 |
Second Address | Steger, IL 60475-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2020 |
Last Update Date | 27/03/2020 |