Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1033306162 |
---|---|
Provider Name | Susanne Baretz |
First Address | Highland Park, IL 60035-3161 |
Second Address | Highland Park, IL 60035-3161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 03/10/2007 |