Individual
AGNESE MACTAVISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1066 W CHATHAM DR, PALATINE, IL 60067-5864
(404) 488-9158
Mailing address
1066 W CHATHAM DR, PALATINE, IL 60067-5864
(404) 488-9158
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.108577
IL
Other
Enumeration date
08/04/2022
Last updated
08/04/2022
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