NPI | 1164456026 |
---|---|
Other Name | NICOLE M GANNON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA SW124543) |
Additional Taxonomies | 104100000X Social Worker (Licence: PA SW124543) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2017-03-01 |