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General NPI Number Information
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NPI Number | 1750836250
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Entity Type | Individual
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Provider Name | MILI LARA
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Gender | Female
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 110 E 11TH AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-2704
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Country | US
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Telephone | 630-420-6332
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Fax |
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Provider Business Mailing Address
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Address Line | 735 MARKET DR
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City | OSWEGO
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State | IL
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Zip | 60543-4043
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Country | US
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Telephone | 630-636-6909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 158
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License Number State | IL
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