| NPI | 1942461223 |
|---|---|
| Former Name | CODY ELIZABETH PORTWINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 2382) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 768) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2012-10-04 |