| NPI | 1376109272 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851109762) | 
| Additional Taxonomies | 106S00000X Behavior Technician | 
| Enumeration Date | 2019-05-15 | 
| Last Update Date | 2025-05-07 |