| NPI | 1376138602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171W00000X Contractor |
| 251S00000X | |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-03-21 |