| NPI | 1023362035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE J JENSEN Licensed Clinical Social Worker 307-217-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 661) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |