| NPI | 1801482773 |
|---|---|
| Former Name | JESSICA KAITLYN VANDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 7577) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: GA MSW010269) | |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2023-08-30 |