Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 180002668 | IL |
NPI | 1003178187 |
---|---|
Provider Name | Santa M. Houdek |
First Address | Elk Grove Village, IL 60007-3217 |
Second Address | Elk Grove Village, IL 60007-3217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 13/06/2012 |