| NPI | 1104064195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 935) |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-524) | |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2017-08-16 |