NPI | 1639540073 |
---|---|
Former Name | JESICA KOSSA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801104075) |
Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801098585) |
Enumeration Date | 2015-10-12 |
Last Update Date | 2024-02-22 |