| NPI | 1356840375 |
|---|---|
| Former Name | KACI LYNN BALLWEG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1353-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 584-228) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2024-02-28 |