| NPI | 1093022527 |
|---|---|
| Former Name | SHAWNENE JAYNE NICKERSON-KIESER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW31784) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-24582) |
| 1041S0200X Social Worker, School (Licence: ID LMSW-24582) | |
| 1041C0700X Social Worker, Clinical (Licence: NE LICSW 1433) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID Certif 10089 Ref 743) | |
| 1041S0200X Social Worker, School (Licence: ID Idaho) | |
| 1041C0700X Social Worker, Clinical (Licence: NE LIMHP 964) | |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2012-11-01 |