| NPI | 1639875818 |
|---|---|
| Former Name | KIMBERLY WOGAHN |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 11242-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7220) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2024-08-23 |