| NPI | 1043324353 |
|---|---|
| Former Name | KIMBERLY JANE WATEROUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180-005544) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180005544) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-05-10 |