| NPI | 1356324073 |
|---|---|
| Former Name | KATHLEEN STACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 11475) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904006645) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2010-06-17 |