NPI | 1114104098 |
---|---|
Former Name | STACY LYNN MAYNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005864A) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 255048) |
1041C0700X Social Worker, Clinical (Licence: OR l13060) | |
Enumeration Date | 2008-01-23 |
Last Update Date | 2022-04-27 |