| NPI | 1639443674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN W WADDELL Independent Practitioner 7852-664-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: KS LSCSW 1081) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |