NPI | 1659854107 |
---|---|
Former Name | ARIELLE WILDER EAGAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.022413) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 121791) |
Enumeration Date | 2018-09-11 |
Last Update Date | 2023-09-22 |