| NPI | 1588103824 |
|---|---|
| Former Name | KATHERINE GUSTAFSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 7116) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2026-04-27 |