| NPI | 1033496450 |
|---|---|
| Former Name | STACIE RENAE REYNOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 03708) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 03708) |
| 1041S0200X Social Worker, School (Licence: IA 03708) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |