| NPI | 1114430667 |
|---|---|
| Former Name | JESSICA KELLY LUCASON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C002877) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 009331) |
| 1041C0700X Social Worker, Clinical (Licence: CA 21347) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-06-16 |