| NPI | 1336621978 |
|---|---|
| Former Name | KAITLIN ANTOINETTE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9346-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 130196-121) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2023-03-17 |