| NPI | 1407075989 |
|---|---|
| Former Name | KELLI ANN BACKSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 114135) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-11-17 |