Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180.007260 | IL |
NPI | 1003123167 |
---|---|
Provider Name | Theresa B Mikosz |
First Address | Hoffman Estates, IL 60169-5029 |
Second Address | Hoffman Estates, IL 60169-5029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 08/07/2015 |