| NPI | 1104329432 |
|---|---|
| Former Name | KELSEY ANN MADER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 9224) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2021-02-17 |