NPI | 1639953102 |
---|---|
Former Name | KARLIE JO KORISH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 29517) |
Additional Taxonomies | 104100000X Social Worker (Licence: MN 29517) |
Enumeration Date | 2023-08-24 |
Last Update Date | 2024-01-22 |