| NPI | 1922758192 |
|---|---|
| Former Name | KELLY WASON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904012926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200001860) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-04-08 |