| 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 |