NPI | 1578070124 |
---|---|
Former Name | JESSICA MATCZAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021262) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801102083) |
1041C0700X Social Worker, Clinical (Licence: MI 6801106500) | |
Enumeration Date | 2018-01-04 |
Last Update Date | 2020-12-27 |