| NPI | 1356476667 |
|---|---|
| Former Name | JACKIE LINDBLAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 282) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2634) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |