Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0712398 | IL |
NPI | 1114001690 |
---|---|
Provider Name | Victoria V Lavigne |
First Address | Northfield, IL 60093-1209 |
Second Address | Northfield, IL 60093-1209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |