| NPI | 1558646323 |
|---|---|
| Former Name | STACY M ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149024521) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MO 2013042874) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2013033734) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2023-01-06 |