| NPI | 1962135285 |
|---|---|
| Former Name | MARIA LYN WIEDENKELLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7624-226) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 113992) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2024-06-03 |