| NPI | 1912565342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 31841) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 104100000X Social Worker (Licence: MN 31841) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2025-08-22 |