| NPI | 1811514821 |
|---|---|
| Former Name | STEPHANIE MICHELLE WILGUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX LCSW64567) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS23247) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |