| NPI | 1609171966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2011022083) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 4026) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 2011022083) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2013-03-08 |