Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2489765 | IL |
NPI | 1033724232 |
---|---|
Provider Name | Shadequia Davis |
First Address | Chicago, IL 60605-2956 |
Second Address | Joliet, IL 60433-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |