| NPI | 1669928743 |
|---|---|
| Former Name | JESSICA LYNN DEHAVEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 7619-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 6936-S) |
| 1041C0700X Social Worker, Clinical (Licence: NV IC-931) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2020-09-22 |