NPI | 1083174932 |
---|---|
Former Name | TAMMY LYNN RUTERBUSCH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801106282) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801099721) |
Enumeration Date | 2019-03-25 |
Last Update Date | 2023-01-31 |