| NPI | 1174989230 |
|---|---|
| Former Name | MADELINE J BANNECK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 247200000X Technician, Other |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2022-07-21 |