| NPI | 1023268737 |
|---|---|
| Former Name | LORI B WIDRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 7943-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 127337) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15435-131) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15406-132) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2014-01-15 |