Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 178.012006 | IL |
N | 225C00000X | Rehabilitation Counselor | 00119046 | IL |
NPI | 1144767161 |
---|---|
Provider Name | Sarah Martini |
First Address | Willowbrook, IL 60527-7607 |
Second Address | Willowbrook, IL 60527-7607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2017 |
Last Update Date | 28/01/2017 |