| NPI | 1932881075 |
|---|---|
| Former Name | HEATHER JEAN NICKLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851116753) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851116753) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |