| NPI | 1477951192 |
|---|---|
| Former Name | JACQUELINE E OMENITSCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 147557) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 18453) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2019-09-24 |