| NPI | 1578975173 |
|---|---|
| Former Name | KARISSA MARIE BAUDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 1204-6-15-22A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1727) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2023-02-08 |