| NPI | 1457876351 |
|---|---|
| Former Name | AMANDA STAUTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 18231-130) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2017-08-11 |