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General NPI Number Information
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NPI Number | 1114237153
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS UNIVERSITY
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 146 WIRTZ HALL
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City | DEKALB
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State | IL
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Zip | 60115-3088
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Country | US
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Telephone | 815-753-1684
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Fax | 815-753-1627
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Provider Business Mailing Address
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Address Line | 146 WIRTZ HALL
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City | DEKALB
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State | IL
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Zip | 60115-3088
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Country | US
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Telephone | 815-753-1684
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Fax | 815-753-1627
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Authorized Official
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Title or Position | ASSISTANT, DEAN/FINANCE OPERATIONS
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Name | DAWN ROZNOWSKI
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Credential |
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Telephone | 815-753-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000169
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License Number State | IL
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