| NPI | 1417243023 |
|---|---|
| Former Name | AMANDA BROOKE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149017020) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34006529A) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2016-07-12 |