| NPI | 1629141163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINA MARIA TEOFILO MATTSON COO 612-805-0395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149003431) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-08-11 |