NPI | 1629480355 |
---|---|
Former Name | CASEY THEIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 072407) |
Additional Taxonomies | 104100000X Social Worker (Licence: IA 072407) |
Enumeration Date | 2014-05-29 |
Last Update Date | 2018-01-09 |