| NPI | 1205088721 |
|---|---|
| Former Name | KASEY L BOLK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2010022046) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2758) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2023-09-15 |