| NPI | 1669072526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE HAKKEN Owner 269-329-8708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-31 |