NPI | 1518474139 |
---|---|
Former Name | KALLIE N REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019015457) |
Additional Taxonomies | 104100000X Social Worker (Licence: MO 2016029239) |
Enumeration Date | 2018-01-04 |
Last Update Date | 2021-11-10 |